Measuring sustainability in healthcare: an analysis of two systems providing insoles to patients with diabetes
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Measuring sustainability in healthcare: an analysis of two systems providing insoles to patients with diabetes Stefan Hellstrand1 · L. Sundberg2 · J. Karlsson3 · R. Zügner3 · R. Tranberg3 · Ulla Hellstrand Tang3,4 Received: 17 May 2019 / Accepted: 21 July 2020 © The Author(s) 2020
Abstract There is an increasing demand to quantify the footprints, ecological, economic and social, in terms of the effect of different interventions in healthcare. The aim of this study was to compare two systems providing patients with diabetes with insoles in terms of their ecological, economic and social footprints. Prefabricated insoles (PRI) were compared with custom-made insoles (CMI). Using a welfare-economic monetary approach, costs were estimated for (1) treatment, (2) travelling to and from the hospital in terms of both fuel and time consumed by the patients and (3) society through emissions contributing to climate change. The proportion of patients/year that could be supplied within the same budget, for each individual treatment, was calculated. The cost of the insoles was 825 SEK (PRI) and 1450 SEK (CMI), respectively. The cost, mean value/patient due to the consumption of patients’ time at the department, was 754 SEK (PRI) and 1508 SEK (CMI), respectively. Emissions, in terms of C O2 equivalent, were 13.7 (PRI) and 27.4 (CMI), respectively. Using PRI, a total of 928 patients could be provided/year compared with 500 patients if CMI are used. By using PRI, the cost/treatment was reduced by 46%. The cost of treatment dominated and the cost of time consumed by patients were also substantial. The societal cost of contributing to climate change was of low importance. By using PRI, the needs of 86% more patients could be met within the same budget. Using these methods, the contribution of healthcare systems to the 17 Sustainable Development Goals approved by the UN can be quantified. Keywords Healthcare · Sustainability · Diabetes · Diabetic foot · Non-communicable diseases · Sustainable Development Goals
* Ulla Hellstrand Tang [email protected] 1
Nolby Ekostrategi, Tolita 8, 665 92 Kil, Sweden
2
Gothenburg Diabetes Association, Mellangatan 1, 413 01 Göteborg, Sweden
3
The Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 43180 Mölndal, Sweden
4
The Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Falkenbergsgatan 3, 412 85 Göteborg, Sweden
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Abbreviations DFU Diabetic foot ulcers CO2 Carbon dioxide CMI Custom-made insoles CPO Certified prosthetist and orthotist DPO Department of Prosthetics and Orthotics ha Hectare NCD Non-communicable diseases PRI Prefabricated insoles SDG Sustainable Development Goals UN United Nations WHO World Health Organisation
1 Introduction Insoles and appropriate footwear are frequently used to prevent pressure-induced diabetic foot ulcers (DFU) and footwear enables people to walk (World Health Organisation 2016). The ability to
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