Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study
Introduction To compare the clinical outcomes and healthcare utilization of patients enrolled in the multidisciplinary Diabetic Foot in Primary and Tertiary (DEFINITE) Care program with a matched historical cohort and estimate the program’s long-term cost-effectiveness using simulation.Research desi...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Diabetes Research & Care |
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| author | Yan Sun Xiaoli Zhu Jaime Lin John Abisheganaden Zhiwen Joseph Lo Lixia Ge Joseph Molina Elaine Tan Huiling Liew Jeremy Hoe Gary Ang Kai Qiang Low Theophilus Yap Nur Aberleen Syafirah Binte Azmi Enming Yong Tiffany Chew Hui Yan Koo Chelsea Law Dexter Yak Seng Chan Claris Shi Julia Choo Wai Han Hoi Sadhana Chandraskear Jo Ann Lim Jemes Siow Sabariah Binte Kaspon Subramaniam Tavintharan Daniel Chew |
| author_facet | Yan Sun Xiaoli Zhu Jaime Lin John Abisheganaden Zhiwen Joseph Lo Lixia Ge Joseph Molina Elaine Tan Huiling Liew Jeremy Hoe Gary Ang Kai Qiang Low Theophilus Yap Nur Aberleen Syafirah Binte Azmi Enming Yong Tiffany Chew Hui Yan Koo Chelsea Law Dexter Yak Seng Chan Claris Shi Julia Choo Wai Han Hoi Sadhana Chandraskear Jo Ann Lim Jemes Siow Sabariah Binte Kaspon Subramaniam Tavintharan Daniel Chew |
| author_sort | Yan Sun |
| collection | DOAJ |
| description | Introduction To compare the clinical outcomes and healthcare utilization of patients enrolled in the multidisciplinary Diabetic Foot in Primary and Tertiary (DEFINITE) Care program with a matched historical cohort and estimate the program’s long-term cost-effectiveness using simulation.Research design and methods This study consisted of two components: a 1-year observational outcome evaluation and a long-term simulation-based cost-effectiveness analysis (CEA). We conducted an observational study to analyze 2798 patients with diabetic foot ulcers (DFUs) enrolled in the program between June 2020 and June 2021 (DEFINITE Care group) and 5462 patients with DFUs from June 2016 to December 2017 as historical controls. One-to-one propensity score matching (PSM) with replacement was conducted to estimate the treatment effect of the program on clinical outcomes and healthcare utilization over 1 year. For the simulation component, a long-term CEA was performed using a Markov state transition model on a simulated cohort of 10 000 patients with DFUs over a 20-year period, assessing transitions between health states, including minor and major amputations and death. The incremental cost-effectiveness ratio (ICER) was calculated for the DEFINITE Care program relative to routine care.Results The estimation of average treatment effects based on propensity scores showed that the DEFINITE Care group exhibited a 9% lower mortality, 5% higher lower extremity amputation (LEA)-free survival, yet a 5% higher minor LEA rate compared with the matched historical controls. Additionally, they experienced fewer inpatient admissions (0.98 fewer episodes) and shorter hospital stays (5.5 fewer days) within 1 year (p-value <0.001). The ICER was US$22 707 (SE: 430) per quality-adjusted life year gained, indicating long-term cost-effectiveness. Probabilistic sensitivity analysis supported these findings.Conclusions The integrated multidisciplinary DEFINITE Care program improved LEA-free survival, reduced inpatient admissions and length of stay within 1 year and demonstrated long-term cost-effectiveness managing DFUs. |
| format | Article |
| id | doaj-art-eaeb8928d1484f2c916064734f27e55d |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-eaeb8928d1484f2c916064734f27e55d2025-01-20T07:35:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972025-01-0113110.1136/bmjdrc-2024-004688Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation studyYan Sun0Xiaoli Zhu1Jaime Lin2John Abisheganaden3Zhiwen Joseph Lo4Lixia Ge5Joseph Molina6Elaine Tan7Huiling Liew8Jeremy Hoe9Gary Ang10Kai Qiang Low11Theophilus Yap12Nur Aberleen Syafirah Binte Azmi13Enming Yong14Tiffany Chew15Hui Yan Koo16Chelsea Law17Dexter Yak Seng Chan18Claris Shi19Julia Choo20Wai Han Hoi21Sadhana Chandraskear22Jo Ann Lim23Jemes Siow24Sabariah Binte Kaspon25Subramaniam Tavintharan26Daniel Chew27Health Services and Outcomes Research, National Healthcare Group, SingaporeNational Healthcare Group Polyclinics, SingaporeDepartment of Endocrinology, Woodlands Health, SingaporeHealth Services and Outcomes Research, National Healthcare Group, SingaporeDepartment of Surgery, Woodlands Health, SingaporeHealth Services and Outcomes Research, National Healthcare Group, SingaporeHealth Services and Outcomes Research, National Healthcare Group, SingaporeNational Healthcare Group Polyclinics, SingaporeDepartment of Endocrinology, Tan Tock Seng Hospital, SingaporeDepartment of General Medicine, Khoo Teck Puat Hospital, SingaporeHealth Services and Outcomes Research, National Healthcare Group, SingaporeNational Healthcare Group Polyclinics, SingaporeNational Healthcare Group Polyclinics, SingaporeNational Healthcare Group Polyclinics, SingaporeDepartment of General Surgery, Tan Tock Seng Hospital, SingaporeDepartment of Podiatry, Tan Tock Seng Hospital, SingaporeDepartment of Endocrinology, Tan Tock Seng Hospital, SingaporeDepartment of Podiatry, Khoo Teck Puat Hospital, SingaporeDepartment of General Surgery, Khoo Teck Puat Hospital, SingaporeDepartment of Orthopaedics Surgery, Khoo Teck Puat Hospital, SingaporeClinical Transformation, National Healthcare Group, SingaporeDepartment of Endocrinology, Woodlands Health, SingaporeDepartment of General Surgery, Woodlands Health, SingaporeDepartment of Podiatry, Woodlands Health, SingaporeDepartment of Orthopaedic Surgery, Woodlands Health, SingaporeDepartment of General Surgery, Woodlands Health, SingaporeDepartment of General Medicine, Khoo Teck Puat Hospital, SingaporeTan Tock Seng Hospital, SingaporeIntroduction To compare the clinical outcomes and healthcare utilization of patients enrolled in the multidisciplinary Diabetic Foot in Primary and Tertiary (DEFINITE) Care program with a matched historical cohort and estimate the program’s long-term cost-effectiveness using simulation.Research design and methods This study consisted of two components: a 1-year observational outcome evaluation and a long-term simulation-based cost-effectiveness analysis (CEA). We conducted an observational study to analyze 2798 patients with diabetic foot ulcers (DFUs) enrolled in the program between June 2020 and June 2021 (DEFINITE Care group) and 5462 patients with DFUs from June 2016 to December 2017 as historical controls. One-to-one propensity score matching (PSM) with replacement was conducted to estimate the treatment effect of the program on clinical outcomes and healthcare utilization over 1 year. For the simulation component, a long-term CEA was performed using a Markov state transition model on a simulated cohort of 10 000 patients with DFUs over a 20-year period, assessing transitions between health states, including minor and major amputations and death. The incremental cost-effectiveness ratio (ICER) was calculated for the DEFINITE Care program relative to routine care.Results The estimation of average treatment effects based on propensity scores showed that the DEFINITE Care group exhibited a 9% lower mortality, 5% higher lower extremity amputation (LEA)-free survival, yet a 5% higher minor LEA rate compared with the matched historical controls. Additionally, they experienced fewer inpatient admissions (0.98 fewer episodes) and shorter hospital stays (5.5 fewer days) within 1 year (p-value <0.001). The ICER was US$22 707 (SE: 430) per quality-adjusted life year gained, indicating long-term cost-effectiveness. Probabilistic sensitivity analysis supported these findings.Conclusions The integrated multidisciplinary DEFINITE Care program improved LEA-free survival, reduced inpatient admissions and length of stay within 1 year and demonstrated long-term cost-effectiveness managing DFUs.https://drc.bmj.com/content/13/1/e004688.full |
| spellingShingle | Yan Sun Xiaoli Zhu Jaime Lin John Abisheganaden Zhiwen Joseph Lo Lixia Ge Joseph Molina Elaine Tan Huiling Liew Jeremy Hoe Gary Ang Kai Qiang Low Theophilus Yap Nur Aberleen Syafirah Binte Azmi Enming Yong Tiffany Chew Hui Yan Koo Chelsea Law Dexter Yak Seng Chan Claris Shi Julia Choo Wai Han Hoi Sadhana Chandraskear Jo Ann Lim Jemes Siow Sabariah Binte Kaspon Subramaniam Tavintharan Daniel Chew Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study BMJ Open Diabetes Research & Care |
| title | Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study |
| title_full | Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study |
| title_fullStr | Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study |
| title_full_unstemmed | Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study |
| title_short | Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study |
| title_sort | outcome evaluation and cost effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program a combined observational and simulation study |
| url | https://drc.bmj.com/content/13/1/e004688.full |
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