Cost-Effectiveness of Prevention and Management of Diabetic Foot Ulcer and Amputation in a Health Resource-limited Setting

Background To estimate the lifetime health and economic effects of different strategies of caring the diabetic foot in the Chinese setting. Methods A mathematical model was developed to simulate the onset and progression of diabetic foot disease in patients with type 2 diabetes managed with optimal care and usual care. Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese health care setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results. Heath benefits and costs were the outcome measures assessed. Results Compared with usual care, optimal care was a cost-saving option that exhibited lower costs with improved health benefits, including greater quality-adjusted life-years (QALYs) and reduced incidence of foot complications. The lifetime saving costs per additional QALY gained by optimal care was US $2,015. The model outcome was most sensitive to the risk ratio of foot ulcers and amputation for optimal care over usual care. Conclusions Implementing the guideline-based optimal care for diabetic foot is likely to be cost-effective in a health resource-limited setting.