1505Cost-effectiveness of guideline-based care for diabetes-related foot ulcers: using discrete event simulation in economic evaluation. (2nd September 2021)

• Record Type: Journal Article
• Authors: Zhang, Yuqi; Carter, Hannah; Lazzarini, Peter; Cramb, Susanna; Pacella, Rosana; Netten, Jaap van; Cheng, Qinglu; Derhy, Patrick; Kinnear, Ewan; McPhail, Steven
• Is Part Of: International journal of epidemiology. Volume 50(2021)Supplement 1
• Publication Date: 2021-09-02
• Subjects: Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyab168.754
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: Implementation of guideline-based care for diabetes-related foot ulcers (DFU) in clinical practice is typically sub-optimal. We aimed to evaluate the cost-effectiveness of implementing different incremental increases in guideline-based care scenarios, compared with current practice, using discrete event simulation models. Methods: The costs and effectiveness of current practice (identified as 30% receiving guideline-based care, remainder (70%) non-guideline-based care) were compared with seven hypothetical scenarios of implementing incremental increases in guideline-based care (40%, 50%, 60%, 70%, 80%, 90%, 100%) and evaluated using discrete event simulation models, including important events of disease history and parameterised by a large DFU cohort. Incremental cost-effectiveness ratio for each scenario was calculated and compared to willingness-to-pay of AUD28, 000 per quality-adjusted life-years (QALY). Probability sensitivity analysis was conducted to incorporate parameter uncertainty by 2, 000 random simulations. Results: Under a three-year time-horizon, the seven scenarios (40%-100% guideline-based care) were estimated to incrementally save $901-$1843 (AUD 2020) and provide 0.017-0.056 more QALY per person, with all scenarios being cost-saving & more effective than current practice (30% guideline-based care). From probability sensitivity analyses we were increasingly confident (69.7%-89.8% confident) that implementing increased incremental scenarios (40%-100% guideline-based care) would be cost-effective compared with current practice (59.8%-73.4% confident). Conclusions: All scenarios incrementally increasing guideline-based care were evaluated to be cost-saving and more effective than current practice according to this discrete event simulation modelling based on a large real-world cohort. Key messages: Our findings support the cost-effectiveness of implementing any incremental increase in guideline-based care compared to current practice.