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Implementing evidence-based care across Australia would save $2.7 billion over 5 years

Investing in evidence-based care for Australians with diabetic foot ulcers will cost more money in the short-term but save $2.7 billion over five years for Australia according to a new article published in the International Wound Journal.

Health economic and diabetic foot researchers from the Queensland University of Technology (QUT) and the Wound CRC collaborated on an extensive cost modelling study, finding staggering cost savings when people with diabetic foot disease receive evidence-based care that is fully subsidised within the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). If patients receive evidence-based diabetic foot care compared to usual care, over 5 years savings of >$9,000 per person aged under 75 years, and >$12,000 per person aged over 75 years result. If all affected people in Australia received this evidence-based care, this would translate to $2.7 billion in savings to Australia, even after factoring in the increased investment in resources. Perhaps even more important, these significant cost savings were accompanied by an increase in quality of life.

These findings confirm the importance of evidence-based diabetic foot care, which is what clinicians have been advocating for years, but is still not implemented within the MBS and PBS. This should encourage politicians and health care managers to invest in evidence-based diabetic foot care now.

The method used by the QUT-led research team is called “Markov modelling”, a widely used that has been successfully applied to diabetic foot care in other settings in the past. In this contemporary Australian study, 10,000 simulated patients were followed over time using sophisticated and widely-used statistical modelling. Patient information was based on data from the best available Australian diabetic foot ulcer scientific studies and real-life costs. The model starts with patients either having an uncomplicated diabetic foot ulcer or a complicated infected ulcer. The simulated patients are then followed over five years using Australian data and statistical modelling to determine the probabilities of transitioning to being healed, re-ulcerating, hospitalised, amputated and/or dying.

In the Markov model, different probabilities of healing and ulcer recurrence are used depending on whether individuals are treated with usual care or evidence-based optimal care, while at the same time factoring the different treatment costs associated with providing usual care and optimal care. The clinical outcomes used in the study are based on large Australian cohort studies, and the costs based on actual Australian costs of dressings, offloading devices and footwear. Together, this creates a strong model and a unique opportunity to investigate the cost-effectiveness of evidence-based optimal care for diabetic foot disease in Australia.

While the researchers concede there is always some uncertainty to the assumptions made to inform any Markov model, they also performed sensitivity analyses to account for this uncertainty and the randomness of any population. Using these additional analyses they still found the probability that optimal care is cost-effective to be always higher than that of usual care. The researchers indicate in the paper that they are already evaluating more specific real-life data obtained from a large Queensland diabetic foot database. Using these models which will add further fine detail to inform policy on the investment of diabetic foot services. However, the results of this robust economic study should lead to changes in clinical practice now.

It is clear from this study that we should invest in evidence-based diabetic foot care, as that will lead to great benefits in quality of life of people with diabetic foot disease, and to a significant reduction in costs for the Australian health system.