On the decision rules of cost-effective treatment for patients with diabetic foot syndrome

Objective: To assess the cost-effectiveness of two treatments (medical treatment and amputation) in patients with diabetic foot syndrome, one of the most disabling diabetic complications. Diabetes mellitus is a massive health care problem worldwide with a current prevalence of 150 millions diabetic cases, estimated to increase to 300 million cases in 2025. Methods: Integrating medical knowledge and advances into the clinical setting is often difficult due to the complexity of the algorithms and protocols. Clinical decision support systems assist the clinician in applying new information to patient care through the analysis of patient-specific clinical variables. We require strategic decision support to analyze the cost-effectiveness of these programs compared to the status quo. We provide a simple partially observable Markov model to investigate that issue, and we propose an heuristic algorithm to find the best policy of intervention. Results: This study assesses the potential cost-effectiveness of two alternative treatment interventions in patients with diabetic foot syndrome. The implementation of the heuristic algorithm solution will assist doctors in clinical decision making, and health care organizations in evaluating medication choices for effective treatment. Finally, our study reveals that treatment programs are highly cost-effective for patients at high risk of diabetic foot ulcers and lower extremity amputations.

[1]  W. Jeffcoate,et al.  The diabetic foot : an illustrated guide to management , 1995 .

[2]  E. Faglia,et al.  Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study. , 2003, Diabetes care.

[3]  S. Kaplan,et al.  Foot infections in diabetic patients. Decision and cost-effectiveness analyses. , 1995, JAMA.

[4]  M. Rauner,et al.  Model-Based Evaluation of Diabetic Foot Prevention Strategies in Austria , 2005, Health care management science.

[5]  E. Weledji,et al.  The Diabetic Foot , 2015 .

[6]  A. Boulton,et al.  The global burden of diabetic foot disease , 2005, The Lancet.

[7]  Edward J. Sondik,et al.  The Optimal Control of Partially Observable Markov Processes over the Infinite Horizon: Discounted Costs , 1978, Oper. Res..

[8]  D. Armstrong,et al.  Preventing foot ulcers in patients with diabetes. , 2005, JAMA.

[9]  I Tarawneh,et al.  A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. , 2001, Diabetes care.

[10]  R. Frykberg,et al.  Diabetic foot ulcers: pathogenesis and management. , 2002, American family physician.

[11]  J Larsson,et al.  What is the most effective way to reduce incidence of amputation in the diabetic foot? , 2000, Diabetes/metabolism research and reviews.

[12]  B. O'brien,et al.  Economic evaluation of pharmaceuticals. Frankenstein's monster or vampire of trials? , 1996, Medical care.

[13]  Athanassios,et al.  Australia and New Zealand Health Policy Open Access Medical Decision Making for Patients with Parkinson Disease under Average Cost Criterion , 2022 .

[14]  E H Wagner,et al.  Incidence, outcomes, and cost of foot ulcers in patients with diabetes. , 1999, Diabetes care.

[15]  Dimitri P. Bertsekas,et al.  Dynamic Programming and Optimal Control, Two Volume Set , 1995 .

[16]  Paul Wach,et al.  A model to analyse costs and benefit of intensified diabetic foot care in Austria. , 2007, Journal of evaluation in clinical practice.

[17]  A. Bal,et al.  Diabetic foot infections: a study of microorganisms associated with the different Wagner grades. , 1998, Indian journal of pathology & microbiology.

[18]  J. Apelqvist,et al.  Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations , 2001, Diabetologia.

[19]  W. Lovejoy.  A survey of algorithmic methods for partially observed Markov decision processes , 1991 .

[20]  Michael O'Grady,et al.  Projecting the Future Diabetes Population Size and Related Costs for the U.S. , 2009, Diabetes Care.

[21]  E. J. Sondik,et al.  The Optimal Control of Partially Observable Markov Decision Processes. , 1971 .

[22]  James S. M. Tan.  Foot Infections in diabetic patients , 2004, Current infectious disease reports.

[23]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[24]  J. Calhoun,et al.  Treatment of Diabetic Foot Infections: Wagner Classification, Therapy, and Outcome , 1988, Foot & ankle.

[25]  L. Niessen,et al.  Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. , 2004, Diabetes care.