Boodoo Chris, Perry Julie A, Leung General, Cross Karen M, Isaranuwatchai Wanrudee
Department of Medical Imaging (Boodoo, Leung), Division of Plastic Surgery (Perry, Cross), Centre for Excellence in Economic Analysis Research (Isaranuwatchai) and Keenan Research Centre for Biomedical Science (Leung, Cross), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Isaranuwatchai), University of Toronto, Toronto, Ont.
CMAJ Open. 2018 Oct 18;6(4):E486-E494. doi: 10.9778/cmajo.20180088. Print 2018 Oct-Dec.
One of the most common (and costly) complications of diabetes are diabetic foot ulcers, which often result in lower-extremity amputation. Regular foot care can reduce complications; however, roughly half of Canadians with diabetes do not participate in screening. We sought to evaluate the economic effects of using telemonitoring for diabetic foot ulcer prevention using mathematical modelling.
We used Markov modelling to compare current screening standards (standard care) to population-wide and targeted (high-risk) telemonitoring programs in a hypothetical cohort of Canadian patients aged 60 years. We varied the effectiveness (or outcome), defined as the proportion of diabetic foot ulcers prevented, to explore cost-effectiveness using model parameters from published literature and clinical experts.
At 20%-40% effectiveness, population-based prevention resulted in 0.00399-0.00790 quality-adjusted life years (QALYs) gained per person over 5 years and an incremental cost of $479-$402 compared to standard care. At 15%-40% effectiveness, high-risk prevention resulted in a cost decrease per person over 5 years ($1.26-$25.55), with health benefits of 0.000207-0.00058 QALYs gained.
The use of telemonitoring in the diabetic lower extremity can offer patients better quality of life and can be cost-effective compared to current Canadian screening practices. Future work should focus on developing and validating technologies based on objective outcome measures for remote monitoring of the diabetic foot.
糖尿病最常见（且代价高昂）的并发症之一是糖尿病足溃疡，其常导致下肢截肢。定期足部护理可减少并发症；然而，约一半的加拿大糖尿病患者未参与筛查。我们试图通过数学建模评估使用远程监测预防糖尿病足溃疡的经济效果。
我们使用马尔可夫模型，在一个假设的60岁加拿大患者队列中，将当前的筛查标准（标准护理）与全人群和针对性（高危人群）远程监测项目进行比较。我们改变有效性（或结果），定义为预防的糖尿病足溃疡比例，利用已发表文献和临床专家的模型参数来探索成本效益。
在有效性为20%-40%时，基于人群的预防措施在5年内每人获得0.00399-0.00790个质量调整生命年（QALY），与标准护理相比，增量成本为479-402美元。在有效性为15%-40%时,高危人群预防措施在5年内每人成本降低（1.26-25.55美元），获得的健康效益为0.000207-0.00058个QALY。
在糖尿病下肢护理中使用远程监测可为患者提供更好的生活质量，与加拿大目前的筛查做法相比，具有成本效益。未来的工作应侧重于基于客观结果指标开发和验证用于糖尿病足远程监测的技术。
