Ortegon Monica Maria, Redekop William Ken, Niessen Louis Wilhelmus
Netherlands Institute of Health Sciences, Erasmus University, Rotterdam, The Netherlands.
Diabetes Care. 2004 Apr;27(4):901-7. doi: 10.2337/diacare.27.4.901.
To estimate the lifetime health and economic effects of optimal prevention and treatment of the diabetic foot according to international standards and to determine the cost-effectiveness of these interventions in the Netherlands.
A risk-based Markov model was developed to simulate the onset and progression of diabetic foot disease in patients with newly diagnosed type 2 diabetes managed with care according to guidelines for their lifetime. Mean survival time, quality of life, foot complications, and costs were the outcome measures assessed. Current care was the reference comparison. Data from Dutch studies on the epidemiology of diabetic foot disease, health care use, and costs, complemented with information from international studies, were used to feed the model.
Compared with current care, guideline-based care resulted in improved life expectancy, gain of quality-adjusted life-years (QALYs), and reduced incidence of foot complications. The lifetime costs of management of the diabetic foot following guideline-based care resulted in a cost per QALY gained of < 25,000 US dollars, even for levels of preventive foot care as low as 10%. The cost-effectiveness varied sharply, depending on the level of foot ulcer reduction attained.
Management of the diabetic foot according to guideline-based care improves survival, reduces diabetic foot complications, and is cost-effective and even cost saving compared with standard care.
根据国际标准评估糖尿病足最佳预防和治疗的终生健康及经济影响，并确定这些干预措施在荷兰的成本效益。
开发了一种基于风险的马尔可夫模型，以模拟按照指南接受终生护理的新诊断2型糖尿病患者糖尿病足疾病的发病和进展情况。评估的结局指标包括平均生存时间、生活质量、足部并发症和成本。以当前护理作为对照。使用来自荷兰糖尿病足疾病流行病学、医疗保健使用和成本研究的数据，并辅以国际研究的信息来构建该模型。
与当前护理相比，基于指南的护理可提高预期寿命，增加质量调整生命年（QALY），并降低足部并发症的发生率。即使预防性足部护理水平低至10%，基于指南的护理对糖尿病足进行终生管理的成本效益比也小于25,000美元/获得的QALY。成本效益因实现的足部溃疡减少水平而异。
与标准护理相比，基于指南的护理管理糖尿病足可提高生存率，减少糖尿病足并发症，具有成本效益，甚至可节省成本。
