Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes/Metabolism Research and Reviews Pub Date : 2024-04-30 DOI:10.1002/dmrr.3805

Jaap J. Van Netten, Wouter B. Aan De Stegge, Marcel G. W. Dijkgraaf, Sicco A. Bus

{"title":"Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial","authors":"Jaap J. Van Netten, Wouter B. Aan De Stegge, Marcel G. W. Dijkgraaf, Sicco A. Bus","doi":"10.1002/dmrr.3805","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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; <i>p</i> = 0.45) because of (significantly) fewer participants with ulcer recurrence(s) in 18 months (36% vs. 47%; <i>p</i> = 0.045); however, QALYs were (non-significantly) lower in the intervention group (1.09 vs. 1.12; <i>p</i> = 0.35), especially in those without foot ulcer recurrence (1.09 vs. 1.17; <i>p</i> = 0.10).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":11335,"journal":{"name":"Diabetes/Metabolism Research and Reviews","volume":"40 4","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/dmrr.3805","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes/Metabolism Research and Reviews","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3805","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

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 and Methods

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.

Abstract Image

查看原文本刊更多论文

通过体温监测预防糖尿病患者足部溃疡复发的成本效益：多中心随机对照试验

目的与糖尿病有关的足部溃疡很常见，费用高昂，而且经常复发。多种干预措施有助于预防这些溃疡。然而，这些干预措施都没有进行过成本效益的前瞻性调查。我们的目的是评估居家皮肤温度监测在预防糖尿病足溃疡复发方面的成本效益。材料与方法多中心随机对照试验。我们将 304 名糖尿病相关足部溃疡高危人群随机分配到常规足部护理加每日居家足部皮肤温度监测（干预）或单纯常规护理（对照）两种方案中。主要结果是基于 18 个月随访期间的足部护理成本和质量调整生命年（QALY）的成本效益。足部护理成本包括溃疡预防成本（如鞋类、足病治疗）和溃疡治疗成本（如咨询、住院、截肢）。采用概率敏感性分析法计算了干预与常规护理的增量成本效益比，支付意愿/接受水平最高为 10 万欧元。结果在接受意愿值为每 QALY 损失 50,000 欧元时，干预措施具有成本效益的概率为 45%。这是因为干预组的足部护理成本较低（6067 欧元 vs. 7376 欧元；p = 0.45），因为在 18 个月内溃疡复发的参与者人数较少（36% vs. 47%；p = 0.045）；但是，干预组的 QALY 较低（1.09 vs. 1.12；p = 0.35），尤其是没有足部溃疡复发的参与者（1.09 vs. 1.17；p = 0.10）。结论在家中进行皮肤温度监测以预防糖尿病相关足部溃疡与常规护理相比，成本效益充其量相当。干预措施可防止足部溃疡复发并节省相关费用，但这是以QALY损失为代价的，QALY损失可能来自于自我监测负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.