Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia.

Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.

A diabetic foot wound healing assessment tool: A scoping review.

Background: Indonesia faces a challenge in controlling the burden of diabetic foot ulcers, which necessitates a nursing care management approach to optimize the healing of complications by accurately monitoring wound healing progress using wound assessment tools. Methods: This literature review, which is part of a scoping study framework, searched electronic databases including PubMed, ScienceDirect, EBSCOhost, and Google Scholar to find papers relevant to the Indonesian context. Five papers were chosen from a total of 463 papers discovered. Results: The diabetic foot ulcer wound assessment tools DFUAS (diabetic foot ulcer assessment scale), DMIST (deep, maceration, infection, size, and tunneling), and MUNGS (maceration, undermining, necrotic, granulation, and symptoms/signs) were identified in the literature review. For leg ulcers, LUMT (leg ulcer measurement tool) and RESVECH 2.0 (Results Expected from Chronic Wound Healing Assessment) were used. DMIST, DFUAS, and MUNGS are used to predict healed and non-healing wounds. LUMT determines the evaluation and documentation of leg ulcers, and RESVECH 2.0 is designed to shorten the duration of chronic wound occurrence. The psychometric properties of the DMIST scale were identified, including reliability, validity, and responsiveness. Conclusions: Five tools for assessing chronic wounds were identified. The predictive validity and responsiveness of the DMIST tool were supported by a sufficient rating based on evidence quality. This scoping review provides an overview of the measurement properties of available assessment tools for diabetic foot ulcers.