Cost-effectiveness of prevention and management of diabetic foot ulcer and amputation in a health resource-limited setting
Cost-effectiveness of prevention and management of diabetic foot ulcer and amputation in a health resource-limited setting
复制标题
在卫生资源有限的环境中预防和管理糖尿病足溃疡和截肢的成本效益。
DOI：
10.1111/1753-0407.12612
复制
发表时间：
2018-04-01
影响因子：
4.5
通讯作者：
Ma, Jing
中科院分区：
文献类型：
--
作者：
Wu, Bin;Wan, Xu;Ma, Jing
背景
本研究的目的是评估在中国环境下糖尿病足不同护理策略对终身健康和经济的影响。
方法
建立了一个数学模型，以模拟接受最佳护理和常规护理的2型糖尿病患者糖尿病足疾病的发病和进展情况。临床和效用数据来源于已发表的文献。考虑了中国医疗环境中的直接医疗成本和资源利用情况。进行了敏感性分析，以测试一系列变量和假设对结果的影响。健康效益和成本是评估的结果指标。
结果
与常规护理相比，最佳护理是一种节约成本的选择，其成本更低且健康效益更佳，包括更高的质量调整生命年（QALYs）以及足部并发症发生率的降低。通过最佳护理每增加一个质量调整生命年所节省的终身成本为2015美元。该模型结果对最佳护理相对于常规护理的足部溃疡和截肢风险比最为敏感。
结论
在医疗资源有限的环境下，对糖尿病足实施基于指南的最佳护理可能具有成本效益。
BackgroundThe aim of the present study was to estimate the lifetime health and economic effects of different strategies of caring for diabetic foot in the Chinese setting.MethodsA mathematical model was developed to simulate the onset and progression of diabetic foot disease in patients with type 2 diabetes managed with optimal care and usual care. Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the effects of a range of variables and assumptions on the results. Heath benefits and costs were the outcome measures assessed.ResultsCompared with usual care, optimal care was a cost-saving option that exhibited lower costs with improved health benefits, including greater quality-adjusted life-years (QALYs) and reduced incidence of foot complications. The lifetime saving costs per additional QALY gained by optimal care were US$2015. The model outcome was most sensitive to the risk ratio of foot ulcers and amputation for optimal care over usual care.ConclusionsImplementing guideline-based optimal care for diabetic foot is likely to be cost-effective in a health resource-limited setting.