Pharmacoeconomic evaluation of pharmacotherapy of patients with diabetic foot syndrome secondary to type 2 diabetes mellitus
DOI:
https://doi.org/10.63341/ijmmr/2.2025.120Keywords:
integrated frequency/ABC/VEN analysis, medicinal prescriptions, anti-bacterial agents, antimicrobial resistance, pharmaceutical provision optimisationAbstract
The increasing prevalence of type 2 diabetes mellitus complicated by diabetic foot syndrome and the prescription of high-cost medicines, which are not included in treatment protocols, significantly raise healthcare expenditures and worsen patient outcomes, making the optimisation of pharmacotherapy both a clinical and economic priority. The purpose of this study was to evaluate the rationality of pharmacotherapy for patients with diabetic foot syndrome using an integrated frequency/ABC/VEN analysis. The study applied frequency analysis to assess prescription patterns ATC-classification, ABC-analysis to classify medicines by expenditure levels, and VEN-analysis to determine their therapeutic importance based on national and international treatment guidelines recommendations for type 2 diabetes mellitus. The results demonstrated that etiological and pathogenetic therapies approaches predominated in clinical practice. Antidiabetic agents accounted for the largest share of prescriptions (23%), while antibiotics were essential for managing infectious complications. The integrated frequency/ABC/VEN-analyses revealed that “essential” medicines (44.19%) predominated over “vital” (23.26%) and “non-essential” categories (32.56%), indicating the insufficiently rational
rescribing practices in accordance with treatment recommendations. However, a high share of healthcare expenditures
was concentrated in a group of high-cost medicines (34.89%), suggesting suboptimal allocation of healthcare resources. The results also highlighted the importance of evidence-based antibiotic selection due to the growing risk of antimicrobial resistance. The study provided a foundation for improving the economic efficiency of pharmacotherapy in patients with diabetic foot syndrome by supporting rational prescribing, optimisation of healthcare expenditures, and the promotion of cost-effective Ukrainian medicines alternatives
Received: 15.11.2025 | Revised: 15.12.2025 | Accepted: 30.12.2025
References
Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic foot ulcers: A review. JAMA. 2023;330(1):62–75.
DOI: 10.1001/jama.2023.10578
Carter MJ, DaVanzo J, Haught R, Nusgart M, Cartwright D, Fife CE. Chronic wound prevalence and the associated
cost of treatment in Medicare beneficiaries: Changes between 2014 and 2019. J Med Econ. 2023;26(1):894–901.
DOI: 10.1080/13696998.2023.2232256
Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE. Global disability burdens of diabetesrelated lower-extremity complications in 1990 and 2016. Diabetes Care. 2020;43(5):964–74. DOI: 10.2337/dc19-1614
Del Core MA, Ahn J, Lewis RB, Raspovic KM, Lalli TAJ, Wukich DK. Republication of “The evaluation and
treatment of diabetic foot ulcers and diabetic foot infections”. Foot Ankle Orthop. 2023;8(3):24730114231193418.
DOI: 10.1177/24730114231193418
Petersen BJ, Linde-Zwirble WT, Tan TW, Rothenberg GM, Salgado SJ, Bloom JD, et al. Higher rates of all-cause
mortality and resource utilization during episodes-of-care for diabetic foot ulceration. Diabetes Res Clin Pract.
;184:109182. DOI: 10.1016/j.diabres.2021.109182
Centers for Disease Control and Prevention. National diabetes statistics report [Internet]. 2024 May 15 [cited 2025
May 10]. Available from: https://www.cdc.gov/diabetes/php/data-research/index.html
McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, epidemiology, and disparities in the burden of
diabetic foot ulcers. Diabetes Care. 2023;46(1):209–21. DOI: 10.2337/dci22-0043
Cortes-Penfield NW, Armstrong DG, Brennan MB, Fayfman M, Ryder JH, Tan TW, et al. Evaluation and management
of diabetes-related foot infections. Clin Infect Dis. 2023;77(3):e1–13. DOI: 10.1093/cid/ciad255
Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A. Health economics of diabetic foot ulcer and recent trends to
accelerate treatment. Foot. 2022;52:101909. DOI: 10.1016/j.foot.2022.101909
Sutrisno E, Sodik JJ, Fakih TM. Cost-effectiveness analysis and medication use for gangrene treatment in type 2
diabetes patients: A systematic literature review. Pharmacia. 2025;72:e144858. DOI: 10.3897/pharmacia.72.e144858
Bakaliuk TH, Маkarchuk NR, Seniuk KM, Stelmakh HO, Sverstiuk AS. Evaluation of the effectiveness of rehabilitation
for diabetic foot syndrome. Zaporozhye Med J. 2023;25(2):115–21. DOI: 10.14739/2310-1210.2023.2.267251
Kostiuk IA, Kosiachenko KL. Integrated ABC/VEN-analysis of medicinal prescribing in pharmacotherapy of bronchial
asthma in children. Curr Issues Pharm Med Sci. 2019;12(2):190–5. DOI: 10.14739/2409-2932.2019.2.171074
World Health Organization. ATC/DDD Index 2025 [Internet]. [cited 2025 May 10]. Available from: https://atcddd.
fhi.no/atc_ddd_index/
Parii VD, Gryshchuk SM. Methods for conducting ABC analysis, VEN analysis, frequency analysis, integrated
frequency/VEN/ABC analysis. In: Parii VD, editor. Health care economics: Textbook. Zhytomyr: Buk-Druk
Publishing House LLC; 2021. P. 197–213.
Order of the Ministry of Health of Ukraine No. 356. Clinical Protocol for the Management of Patients with Diabetic
Foot Syndrome [Internet]. 2009 May 22 [cited 2025 May 10]. Available from: https://www.content.net.ua/registration/
content/ua1622/pages/f12705.html
Resolution of the Cabinet of Ministers of Ukraine No. 333. National List of Essential Medicines [Internet]. 2009
March 25 [cited 2025 May 10]. Available from: https://zakon.rada.gov.ua/laws/show/333-2009-%D0%BF#n15
Order of the Ministry of Health of Ukraine No. 971. On Approval of the Seventeenth Edition of the State Formulary of
Medicinal Products and Ensuring its Availability [Internet]. 2025 June 13 [cited 2025 May 10]. Available from: https://
www.dec.gov.ua/materials/chynnyj-vypusk-derzhavnogo-formulyara-likarskyh-zasobiv/
The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list [Internet]. 2025
September 5 [cited 2025 September 10]. Available from: https://www.who.int/publications/i/item/B09474
National Institute for Health and Care Excellence guideline. Diabetic foot problems: Prevention and management
[Internet]. 2015 August 26 [cited 2025 May 10]. Available from: https://www.nice.org.uk/guidance/ng19/resources/
diabetic-foot-problems-prevention-and-management-pdf-1837279828933
Order of the Ministry of Health of Ukraine No. 1513. On Approval of the Medical Standard “Rational Use of
Antibacterial and Antifungal Medicines for Therapeutic and Prophylactic Purposes” [Internet]. 2023 August 23
[cited 2025 May 10]. Available from: https://moz.gov.ua/uk/decrees/nakaz-moz-ukraini-vid-23082023--1513-prozatverdzhennja-standartu-medichnoi-dopomogi-racionalne-zastosuvannja-antibakterialnih-i-antifungalnih-preparativ-z-likuvalnoju-ta-profilaktichnoju-metoju
World Health Organization. AWaRe classification of antibiotics for evaluation and monitoring of use [Internet].
September 30 [cited 2025 May10]. Available from: https://www.who.int/publications/i/item/2021-awareclassification
The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human
Subjects [Internet]. [cited 2025 May 10]. Available from: https://www.wma.net/what-we-do/medical-ethics/
declaration-of-helsinki/
European Commission. Ethics and Data Protection [Internet]. 2021 July 5 [cited 2025 May 10]. Available from: https://
ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/guidance/ethics-and-data-protection_
he_en.pdf
Myroniuk-Konstantynovych K, Bondaruk I, Bevz T, Demchyshyn Y, Konstantynovych T. P12 Unjustified use of
antibiotics in wartime conditions in Ukraine. JAC Antimicrob Resist. 2024;6(1):dlad143.016. DOI: 10.1093/jacamr/
dlad143.016
Rahayuningsih N, Pratiwi AL, Pebiansyah A. Cost-effectiveness analysis of antibiotic usage in diabetic foot ulcer
patients in Dokter Soekardjo Tasikmalaya Hospital. Int J Appl Pharm. 2022;14(5):123–6. DOI: 10.22159/ijap.2022.
v14s5.25
Jais S, Oe M, Sanada H, Sasongko A, Haryanto H. Evaluating the cost-effectiveness of diabetic foot ulcer management
by wound care specialists in Indonesia. Wound Repair Regen. 2024;32(1):80–9. DOI: 10.1111/wrr.13147
Russo S, Landi S, Simoni S. Cost-effectiveness analysis for managing diabetic foot ulcer (DFU) in USA: Platelet-rich
plasma (PRP) vs standard of care (SoC). Clinicoecon Outcomes Res. 2025;17:157–69. DOI: 10.2147/CEOR.S496616
Alshammari AM, Elnaem MH, Ong SC. Evaluating the economic impact of diabetes mellitus: A hospital-centric cost
analysis in Hail, Saudi Arabia. Clinicoecon Outcomes Res. 2025;17:473–84. DOI: 10.2147/CEOR.S521701
Tochaiwat K, Singweratham N, Nawsuwan K. Cost-effectiveness analysis of diabetic foot ulcer treatment using high
power laser compared to conventional treatment. J Health Sci Thailand. 2024;33(1):77–85.
Ge L, Sun Y, Tan E, Liew H, Hoe J, Lin J, et al. Outcome evaluation and cost-effectiveness analysis for an integrated
multidisciplinary diabetic limb salvage program: A combined observational and simulation study. BMJ Open Diabetes
Res Care. 2025;13(1):e004688. DOI: 10.1136/bmjdrc-2024-004688
Shankar A. Healthcare economics and policy in diabetic foot care. Int J Diabetes Endocrinol. 2025;10(4):85–97.
DOI: 10.11648/j.ijde.20251004.12
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