Implementing a podiatry prescribing mentoring program in a public health service: a cost-description study

BACKGROUND: In the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced. METHODS: This was a cost-description analysis, involving the calculation of costs associated with the development and implementation of a mentoring program to train podiatrists to become endorsed prescribers. Costs were calculated using the Ingredients Method and examined from the perspective of a public health service provider, and the individual learner podiatrist. Breakeven analysis compared the cost of training a podiatry prescriber for endorsement against the potential benefit (savings) made by averting complications of an infected foot ulcer. A sensitivity analysis was conducted to allow for uncertainty in the results of an economic evaluation. RESULTS: Total start-up cost for the podiatry prescriber mentoring program was $13, 251. The total cost to train one learner podiatrist was $30, 087, distributed between the hospital $17, 046 and the individual learner $13, 041. In the setting studied, a podiatry prescriber must avert 0.40 major amputations arising from an infected foot ulcer through prescribing to recover the cost of training. If in-kind training costs are included, total cost increases to $50, 654, and the breakeven point shifts to 0.68 major amputations averted. CONCLUSION: The economic benefits (savings) created by an endorsed prescribing podiatrist over their career in a public health service are likely to outweigh the costs to train a podiatrist to attain endorsement. Further research is required to help understand the effectiveness of podiatry prescribing in reducing diabetic foot related complications and the potential economic impact of podiatry prescribers on this health condition.