Gorden Lim York Tee, Ariel Ying Fangting, Pei Ho, Meng Lingyan, Yi Zhen N G, Graves Nicholas
Wound Care Innovation for the Tropics Programme, Skin Research Institute of Singapore A*STAR Singapore Singapore.
Health Services and Systems Research Duke-NUS Medical School Singapore Singapore.
Health Care Sci. 2022 Sep 19;1(2):58-68. doi: 10.1002/hcs2.17. eCollection 2022 Oct.
To estimate the costs from delaying major amputation in patients with concurrent diabetic foot ulcer and peripheral vascular disease. We seek to model economic benefits from saved costs from promoting timely major amputations among these patients.
Retrospective modeling using data from National University Hospital, Singapore. We identified patients who might have delayed major amputations by applying a hierarchical clustering algorithm. We then modeled the transitions of all patients over time with a Markov process using a number of relevant health states to enable estimation of cost outcomes. We next summarized the expected changes to the bed days used and cost outcomes arising from reassigning some patients who may have had a delayed amputation to timely amputation. The findings from the sample were scaled to reflect national incidence rates for this disease for the years 2014-2019 in Singapore.
Nine of the 137 patients (6.57%) would be suitable for a major amputation at 3 months, yet in reality, their amputation was delayed. Based on this, and assuming a timely amputation is done for the entire population of patients in Singapore we expect annual savings of 264,791 bed days and $211 million in costs. These findings are preliminary and uncertain. The value of this paper is to show a method for estimating outcomes, report the findings from a small sample, and stimulate future research. New cohort studies might be designed to capture a wider range of outcomes and recruit a larger sample of individuals.
评估合并糖尿病足溃疡和外周血管疾病患者延迟大截肢手术所产生的费用。我们试图通过促进这些患者及时进行大截肢手术来节省成本，从而模拟经济收益。
使用新加坡国立大学医院的数据进行回顾性建模。我们通过应用层次聚类算法确定了可能延迟大截肢手术的患者。然后，我们使用马尔可夫过程对所有患者随时间的转变进行建模，使用多个相关健康状态来估计成本结果。接下来，我们总结了将一些可能延迟截肢的患者重新分配为及时截肢后，预计住院天数和成本结果的变化。样本的研究结果按比例缩放，以反映2014 - 2019年新加坡该疾病的全国发病率。
137名患者中有9名（6.57%）在3个月时适合进行大截肢手术，但实际上他们的截肢手术被延迟了。基于此，并假设新加坡所有患者都能及时进行截肢手术，我们预计每年可节省264,791个住院日和2.11亿美元的成本。这些发现是初步且不确定的。本文的价值在于展示一种估计结果的方法，报告小样本的研究结果，并激发未来的研究。可能会设计新的队列研究来获取更广泛的结果，并招募更大样本的个体。
