Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial.
Diabetes Metab Res Rev
; 40(4): e3805, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38686868
ABSTRACT
AIMS:
Diabetes-related foot ulcers are common, costly, and frequently recur. Multiple interventions help prevent these ulcers. However, none of these have been prospectively investigated for cost-effectiveness. Our aim was to evaluate the cost-effectiveness of at-home skin temperature monitoring to help prevent diabetes-related foot ulcer recurrence. MATERIALS ANDMETHODS:
Multicenter randomized controlled trial. We randomized 304 persons at high diabetes-related foot ulcer risk to either usual foot care plus daily at-home foot skin temperature monitoring (intervention) or usual care alone (control). Primary outcome was cost-effectiveness based on foot care costs and quality-adjusted life years (QALY) during 18 months follow-up. Foot care costs included costs for ulcer prevention (e.g., footwear, podiatry) and for ulcer treatment when required (e.g., consultation, hospitalisation, amputation). Incremental cost-effectiveness ratios were calculated for intervention versus usual care using probabilistic sensitivity analysis for willingness-to-pay/accept levels up to 100,000.RESULTS:
The intervention had a 45% probability of being cost-effective at a willingness-to-accept of 50,000 per QALY lost. This resulted from (non-significantly) lower foot care costs in the intervention group (6067 vs. 7376; p = 0.45) because of (significantly) fewer participants with ulcer recurrence(s) in 18 months (36% vs. 47%; p = 0.045); however, QALYs were (non-significantly) lower in the intervention group (1.09 vs. 1.12; p = 0.35), especially in those without foot ulcer recurrence (1.09 vs. 1.17; p = 0.10).CONCLUSIONS:
At-home skin temperature monitoring for diabetes-related foot ulcer prevention compared with usual care is at best equally cost-effective. The intervention resulted in cost-savings due to preventing foot ulcer recurrence and related costs, but this came at the expense of QALY loss, potentially from self-monitoring burdens.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cost-Benefit Analysis
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Diabetic Foot
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Quality-Adjusted Life Years
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
Diabetes Metab Res Rev
Journal subject:
ENDOCRINOLOGIA
/
METABOLISMO
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: