Abstract
ABSTRACT Introduction: Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient. Although a proportion of patients achieve a spontaneous closure of ulcers, others require medical or surgical treatment. Objective: To determine the cost-effectiveness of the intra- and perilesional application of recombinant human epidermal growth factor (rhEGF), as opposed to conventional therapy for the management of patients diagnosed with Wagner’s 3 or 4 diabetic foot ulcer in Colombia. Methodology: Using a Markov model, the process of care of a diabetic patient with diagnosis of Wagner’s 3 or 4 ulcer receiving conventional treatment, or intra- and perilesional rhEGF, is configured. The evaluation cycles of the treatments are weekly over a 5-year horizon and the outcomes evaluated are quality-adjusted life years (QALYs) and the number of amputations avoided by each treatment scheme, in addition to the total costs for treatments. Results: For the analysed base case, in the outcome of amputations, it was found that the factor presents 39 fewer amputations, in a cohort of 100 patients, compared with conventional treatment. Likewise, QALYs are 0.65 more with the use of rhEGF in an average patient. The estimated cost-utility ratio for the base case would be below the threshold established for Colombia. Conclusions: The intra- and perilesional application of rhEGF is a more effective therapeutic option than conventional therapy in the treatment of patients with Wagner’s 3 or 4 diabetic foot ulcers and is cost-effective, taking as an outcome the QALYs for Colombia from the perspective of the health system.
Highlights
Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient
After a consultation with clinical experts, quality-adjusted life years (QALYs) were selected as an integral measure that groups the results in their different health and treatment states and, as an intermediate outcome, the amputations avoided, understood as the incremental among those estimated by the model when using recombinant human epidermal growth factor (rhEGF) and those estimated with conventional therapy only
Per patient treated with rhEGF, there were 0.39 fewer amputations compared to conventional treatment (0.31 versus 0.70, respectively), showing greater effectiveness
Summary
Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient. Conclusions: The intra- and perilesional application of rhEGF is a more effective therapeutic option than conventional therapy in the treatment of patients with Wagner’s 3 or 4 diabetic foot ulcers and is cost-effective, taking as an outcome the QALYs for Colombia from the perspective of the health system. There is the sensitive or motor type; the first is associated with traumatic injuries that do not generate pain, while the second can trigger malformations in the feet, which causes friction with the footwear and, in turn, leads to the formation of pressure ulcers These patients have fine or atrophic skin, which facilitates the formation of fissures and the entry of germs [2]. According to the Latin American Diabetes Association (LADA), ulcers and amputations in diabetic patients constitute an important problem for public health, since their costs are high, both for patients and their families and for the health system – in the latter case due to subsidies for disability conditions and costs for health care [2]
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