Cost-effectiveness of investing in earlier access to diabetic foot services: A multi-centre pre-post study

We evaluated the cost-effectiveness of implementing a novel funding model to incentivise earlier access of patients with diabetes-related foot disease (DFD) to diabetic foot services (DFS).

In this multi-centre pre-post study, we compared the cost, quality-adjusted life year (QALY) and clinical outcomes of patients with diabetes-related foot disease who had usual access to ambulatory DFS (controls) to patients who accessed the new DFS (intervention) across 15 regions in Queensland, Australia. A generalised linear model was used to estimate the difference in controls and intervention group outcomes, and a Bayesian Markov model estimated transition probabilities between seven health states over a 5-year time horizon from an Australian health service perspective.

Overall, 1687 patients were included (830 control, 857 intervention). Compared to controls, the intervention group had a lower projected probability of hospitalisation, particularly after 20 months. The intervention also had reduced costs (-$8429 [95% confidence intervals: -$8461, -$8397]) and increased QALYs (0.06 [0.05, 0.07]) compared to controls. On average, $AU1 invested in the intervention generated a return of $AU7.86 [$7.63, $8.09].

We found investing in earlier access to DFS to be cost-effective and generated considerably improved patient outcomes, cost savings, and return on investment.