A model to estimate cost-savings in diabetic foot ulcer prevention efforts

J Diabetes Complications. 2017 Apr;31(4):700-707. doi: 10.1016/j.jdiacomp.2016.12.017. Epub 2017 Jan 21.


Background: Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur.

Methods: A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence.

Results: PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year.

Conclusions: Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential.

Keywords: Amputation; Cost-effectiveness; Cost-utility study; Diabetic foot ulcer; Economic evaluation; Prevention.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Amputation, Surgical / adverse effects
  • Amputation, Surgical / economics
  • Cohort Studies
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / economics
  • Cost Savings*
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Diabetic Angiopathies / economics
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / prevention & control
  • Diabetic Angiopathies / therapy
  • Diabetic Foot / economics
  • Diabetic Foot / epidemiology
  • Diabetic Foot / prevention & control*
  • Diabetic Foot / therapy
  • Diabetic Neuropathies / economics
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / prevention & control
  • Diabetic Neuropathies / therapy
  • Follow-Up Studies
  • Health Care Costs*
  • Humans
  • Incidence
  • Markov Chains
  • Models, Economic*
  • Prevalence
  • Risk Factors
  • Survival Analysis
  • United States / epidemiology
  • United States Department of Veterans Affairs
  • Veterans Health* / economics