Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study
Authors' conclusion
The integrated multidisciplinary DEFINITE Care program improved LEA-free survival, reduced inpatient admissions and length of stay within 1 year and demonstrated long-term cost-effectiveness managing DFUs.
Study context
- Population
- Patients with diabetic foot ulcers (DFUs)propensity score matched
- Participants
- 2,798 vs 5,462
- Exposure
- DEFINITE Care program vs matched historical controls
- DEFINITE Caren = 2,798
- Historical controlsn = 5,462reference
- Outcome
- Clinical outcomes and healthcare utilization (average treatment effects)
- Follow-up
- 1 year
Methodological detailsone-to-one propensity score matching with replacement, Markov state transition model, 20-year simulation of 10 000 patients
- One-to-one propensity score matching with replacement
- Markov state transition model
- 20-year simulation of 10 000 patients
Main finding
As reported in the abstract
- Mortality, DEFINITE Care vs matched historical controls
- 9% lower
- Lower extremity amputation (LEA)-free survival, DEFINITE Care vs matched historical controls
- 5% higher
- Minor LEA rate, DEFINITE Care vs matched historical controls
- 5% higher
- Inpatient admissions, DEFINITE Care vs matched historical controls (p-value <0.001)
- 0.98 fewer episodes
- Hospital stays, DEFINITE Care vs matched historical controls (p-value <0.001)
- 5.5 fewer days
Observational data: associations, not effects.
Further findings
Long-term cost-effectiveness (incremental cost-effectiveness ratio (ICER), DEFINITE Care vs routine care) · 20 years (simulation)
- ICER per quality-adjusted life year gained (SE: 430)
- US$22 707
- Probabilistic sensitivity analysis supported these findings
Original publication
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. Published 19 January 2025. doi:10.
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