Zhang, Yuqi, Carter, Hannah E., Lazzarini, Peter A., Cramb, Susanna, Pacella, Rosana ORCID: 0000-0002-9742-1957, van Netten, Jaap J., Cheng, Qinglu, Derhy, Patrick H., Kinnear, Ewan M. and McPhail, Steven M. (2022) Cost-effectiveness of guideline-based care provision for patients with diabetes-related foot ulcers: a modelled analysis using discrete-event simulation. Diabetic Medicine, 40 (1):e14961. pp. 1-11. ISSN 0742-3071 (Print), 1464-5491 (Online) (doi:https://doi.org/10.1111/dme.14961)

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Abstract

Aims
The provision of guideline-based care for patients with diabetes-related foot ulcers (DFU) in clinical practice is suboptimal. We estimated the cost-effectiveness of higher rates of guideline-based care, compared with current practice.
Methods
The costs and quality-adjusted life-years (QALYs) associated with current practice (30% of patients receiving guideline-based care) were compared with seven hypothetical scenarios with increasing proportion of guideline-based care (40%, 50%, 60%, 70%, 80%, 90% and 100%). Comparisons were made using discrete event simulations reflecting the natural history of DFU over a 3-year time horizon from the Australian healthcare perspective. Incremental cost-effectiveness ratios were calculated for each scenario and compared to a willingness-to-pay of AUD 28,000 per QALY. Probabilistic sensitivity analyses were conducted to incorporate joint parameter uncertainty.
Results
All seven scenarios with higher rates of guideline-based care were likely cheaper and more effective than current practice. Increased proportions compared with current practice resulted in between AUD 0.28 and 1.84 million in cost savings and 11–56 additional QALYs per 1000 patients. Probabilistic sensitivity analyses indicated that the finding is robust to parameter uncertainty.
Conclusions
Higher proportions of patients receiving guideline-based care are less costly and improve patient outcomes. Strategies to increase the proportion of patients receiving guideline-based care are warranted.

Item Type:	Article
Uncontrolled Keywords:	diabetes; diabetic foot ulcer; cost-effectiveness
Subjects:	H Social Sciences > HD Industries. Land use. Labor > HD61 Risk Management R Medicine > RT Nursing
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing
Last Modified:	11 Jul 2023 13:34
URI:	http://gala.gre.ac.uk/id/eprint/37506

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