A model to estimate cost-savings in diabetic foot ulcer prevention efforts

Neal R. Barshes, Samira Saedi, James Wrobel, Panos Kougias, O. Erhun Kundakcioglu, David G. Armstrong

Research output: Research - peer-reviewArticle

Abstract

Background Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. Methods A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. Results PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. Conclusions Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential.

LanguageEnglish (US)
Pages700-707
Number of pages8
JournalJournal of Diabetes and its Complications
Volume31
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Diabetic Foot
Cost Savings
Costs and Cost Analysis
Incidence
Primary Prevention
Peripheral Arterial Disease
Population
Pamphlets
Cell Phones
Touch
Statistical Models
Amputation
Health Care Costs
Foot
Leg
Delivery of Health Care
Survival
Health

Keywords

  • Amputation
  • Cost-effectiveness
  • Cost-utility study
  • Diabetic foot ulcer
  • Economic evaluation
  • Prevention

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

A model to estimate cost-savings in diabetic foot ulcer prevention efforts. / Barshes, Neal R.; Saedi, Samira; Wrobel, James; Kougias, Panos; Kundakcioglu, O. Erhun; Armstrong, David G.

In: Journal of Diabetes and its Complications, Vol. 31, No. 4, 01.04.2017, p. 700-707.

Research output: Research - peer-reviewArticle

Barshes NR, Saedi S, Wrobel J, Kougias P, Kundakcioglu OE, Armstrong DG. A model to estimate cost-savings in diabetic foot ulcer prevention efforts. Journal of Diabetes and its Complications. 2017 Apr 1;31(4):700-707. Available from, DOI: 10.1016/j.jdiacomp.2016.12.017
Barshes, Neal R. ; Saedi, Samira ; Wrobel, James ; Kougias, Panos ; Kundakcioglu, O. Erhun ; Armstrong, David G./ A model to estimate cost-savings in diabetic foot ulcer prevention efforts. In: Journal of Diabetes and its Complications. 2017 ; Vol. 31, No. 4. pp. 700-707
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AB - Background Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. Methods A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. Results PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. Conclusions Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential.

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