Ollendorf D A, Kotsanos J G, Wishner W J, Friedman M, Cooper T, Bittoni M, Oster G
Policy Analysis Incorporated, Brookline, Massachusetts, USA.
Diabetes Care. 1998 Aug;21(8):1240-5. doi: 10.2337/diacare.21.8.1240.
To estimate the potential economic benefits of selected strategies from published literature--educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes--to reduce the incidence of lower-extremity amputation among individuals with diabetes.
We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years.
The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged > or = 70 years.
Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.
根据已发表文献评估选定策略（教育干预、多学科诊所及治疗性鞋类保险覆盖）对降低糖尿病患者下肢截肢发生率的潜在经济效益。
我们构建了一个模型，以估计一个假设的10000名糖尿病患者队列中下肢截肢的预期发生率及相关成本。预防策略假定针对有足部溃疡病史的个体，并在3年期间评估效益。
3年内降低截肢风险策略的总潜在经济效益（按5%贴现）在200万至300万美元之间（每位有足部溃疡病史的患者为2900至4442美元）。教育干预的效益最高。大部分效益见于年龄≥70岁的个体。
降低下肢截肢风险的策略可能产生可观的经济效益，应成为糖尿病常规护理的标准组成部分。通过政府、私人付款方、医疗服务提供者和生产商以及糖尿病患者之间的合作，可能最好地实现效益。
