RT Journal Article
SR Electronic
T1 Cost-effectiveness of telemonitoring screening for diabetic foot ulcer: a mathematical model
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E486
OP E494
DO 10.9778/cmajo.20180088
VO 6
IS 4
A1 Chris Boodoo
A1 Julie A. Perry
A1 General Leung
A1 Karen M. Cross
A1 Wanrudee Isaranuwatchai
YR 2018
UL http://www.cmajopen.ca/content/6/4/E486.abstract
AB Background: One of the most common (and costly) complications of diabetes are diabetic foot ulcers, which often result in lower-extremity amputation. Regular foot care can reduce complications; however, roughly half of Canadians with diabetes do not participate in screening. We sought to evaluate the economic effects of using telemonitoring for diabetic foot ulcer prevention using mathematical modelling.Methods: We used Markov modelling to compare current screening standards (standard care) to population-wide and targeted (high-risk) telemonitoring programs in a hypothetical cohort of Canadian patients aged 60 years. We varied the effectiveness (or outcome), defined as the proportion of diabetic foot ulcers prevented, to explore cost-effectiveness using model parameters from published literature and clinical experts.Results: At 20%–40% effectiveness, population-based prevention resulted in 0.00399–0.00790 quality-adjusted life years (QALYs) gained per person over 5 years and an incremental cost of $479–$402 compared to standard care. At 15%–40% effectiveness, high-risk prevention resulted in a cost decrease per person over 5 years ($1.26–$25.55), with health benefits of 0.000207–0.00058 QALYs gained.Interpretation: The use of telemonitoring in the diabetic lower extremity can offer patients better quality of life and can be cost-effective compared to current Canadian screening practices. Future work should focus on developing and validating technologies based on objective outcome measures for remote monitoring of the diabetic foot.