Prevention of diabetes-related foot ulcers and amputations: a cost-utilityanalysis based on Markov model simulations

Aims/hypothesis. We analysed the cost-effectiveness of intensified preventi on in diabetic patients with different risks for foot ulcers and lower extr emity amputations. Specifically, we examined whether the additional prevent ion costs associated with present recommendations would be offset by reduce d costs of future foot ulcers and amputations. Methods. Markov-based 5-year cost-utility simulations of current versus opt imal prevention were done for hypothetical cohorts of diabetic patients old er than 24 years. The model included eight possible health states for four risk groups. A population of 1677 diabetes patients provided data on presen t foot ulcer prevention and general mortality. Optimal prevention was defin ed according to the International Consensus on the Diabetic Foot. Model ass umptions, transition probabilities and other data included in the model wer e based on published literature. The main outcome measures were cumulative incidences of foot ulcers, amputations and deaths, costs, cost-effectivenes s, and quality-adjusted life years. Results. An intensified prevention strategy including patient education, fo ot care and footwear is cost-effective if the risk for foot ulcers and lowe r extremity amputations can be reduced by 25 %. This is valid for all patie nts with diabetes except those with no specific risk factors. Conclusion/interpretation. Providing all diabetic patients at risk or high risk for foot ulcers and amputations with adequate prevention would be a co st-effective or even cost-saving strategy.