Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Endocrinology, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
J Diabetes. 2018 Apr;10(4):320-327. doi: 10.1111/1753-0407.12612. Epub 2017 Nov 20.
The aim of the present study was to estimate the lifetime health and economic effects of different strategies of caring for diabetic foot in the Chinese setting.
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 healthcare setting were considered. Sensitivity analyses were undertaken to test the effects of a range of variables and assumptions on the results. Heath benefits and costs were the outcome measures assessed.
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 were US$2015. The model outcome was most sensitive to the risk ratio of foot ulcers and amputation for optimal care over usual care.
Implementing guideline-based optimal care for diabetic foot is likely to be cost-effective in a health resource-limited setting.
本研究旨在评估在中国环境下,不同的糖尿病足护理策略对患者终生健康和经济状况的影响。
我们建立了一个数学模型,以模拟 2 型糖尿病患者在接受最佳护理和常规护理的情况下,糖尿病足疾病的发生和进展。临床和实用数据来自已发表的文献。考虑了中国医疗保健环境中的直接医疗成本和资源利用情况。进行了敏感性分析,以测试一系列变量和假设对结果的影响。评估的结果是健康收益和成本。
与常规护理相比,最佳护理是一种节省成本的选择,具有更好的健康收益,包括更高的质量调整生命年(QALY)和降低足部并发症的发生率。通过最佳护理获得每额外一个 QALY 的终生节省成本为 2015 美元。模型结果对最佳护理相对于常规护理的足部溃疡和截肢风险比最为敏感。
在资源有限的卫生保健环境中,实施基于指南的糖尿病足最佳护理可能具有成本效益。