An economic evaluation examining the cost‐effectiveness of continuous diffusion of oxygen therapy for individuals with diabetic foot ulcers

Background:Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunct to standard methods of care for diabetic foot ulcers (DFU). Its use may decrease the risk of infection and lower extremity amputations (LEAs). As part of a Canadian assessment, we estimated the cost-effectiveness and budget impact of HBOT in this application.Methods:We developed a decision model comparing adjunctive HBOT with standard care alone. The population was a 65-year-old cohort with DFU. The time horizon was 12 years taken from a Ministry of Health perspective. The health states were a healed wound with or without a minor LEA, an unhealed wound with no related surgery, and a major LEA. Efficacy data were based on outcomes reported in studies included in a literature review. Cost and capacity needs for treating DFU patients in Canada were estimated using prevalence data from the literature, and cost and utilization data from government records.Results:The 12-year cost for patients receiving HBOT was CND$40,695 compared with CND$49,786 for standard care alone. Outcomes were 3.64 quality-adjusted life-years (QALYs) for those receiving HBOT and 3.01 QALYs for controls. Estimated cost to treat all prevalent DFU cases in Canada was CND$14.4–19.7 million/year over 4 years. If seven-person HBOT chambers were used, a further nineteen to thirty-five machines would be required nationally.Conclusions:Adjunctive HBOT for DFU is cost-effective compared with standard care. Additional HBOT capacity would be needed if it were to be adopted as the standard of care throughout Canada.

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An economic evaluation of the cost of diabetic foot ulcers: results of a retrospective study on 239 patients

Diabetes & Metabolism ◽

10.1016/s1262-3636(07)70036-8 ◽

2003 ◽

Vol 29 (3) ◽

pp. 269-277 ◽

Cited By ~ 42

Author(s):

I Girod ◽

P Valensi ◽

C Laforêt ◽

T Moreau-Defarges ◽

P Guillon ◽

...

Keyword(s):

Retrospective Study ◽

Economic Evaluation ◽

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

The Cost

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An Evidence-Based Model Comparing the Cost-effectiveness of Platelet-Rich Plasma Gel to Alternative Therapies for Patients with Nonhealing Diabetic Foot Ulcers

Advances in Skin & Wound Care ◽

10.1097/01.asw.0000323589.27605.71 ◽

2008 ◽

Vol 21 (12) ◽

pp. 568-575 ◽

Cited By ~ 56

Author(s):

Edward J. Dougherty

Keyword(s):

Cost Effectiveness ◽

Diabetic Foot ◽

Platelet Rich Plasma ◽

Alternative Therapies ◽

Foot Ulcers ◽

Evidence Based ◽

Diabetic Foot Ulcers ◽

The Cost ◽

Evidence Based Model

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Low-level laser therapy (photobiomodulation) versus hyperbaric oxygen therapy on healing of chronic diabetic foot ulcers: a controlled randomized trial

Physical Therapy Reviews ◽

10.1080/10833196.2021.1876380 ◽

2021 ◽

pp. 1-7

Author(s):

Amir N. Wadee ◽

Siham M. Fahmy ◽

Heba A. Bahey El-Deen

Keyword(s):

Randomized Trial ◽

Laser Therapy ◽

Hyperbaric Oxygen ◽

Diabetic Foot ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Low Level Laser Therapy ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Level Laser

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Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup5.s7 ◽

2021 ◽

Vol 30 (Sup5) ◽

pp. S7-S14

Author(s):

Thomas E Serena ◽

Neal M Bullock ◽

Windy Cole ◽

John Lantis ◽

Lam Li ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Events ◽

Diabetic Foot ◽

Oxygen Therapy ◽

Wound Closure ◽

Foot Ulcers ◽

Controlled Clinical Trial ◽

Diabetic Foot Ulcers ◽

Open Label ◽

Number Of Patients

Objectives: Perfusion and blood oxygen levels are frequently insufficient in patients with hard-to-heal wounds due to poor circulation, vascular disruption and vasoconstriction, reducing the wound's capacity to heal. This study aimed to investigate the effect of topical oxygen on healing rates in patients with hard-to-heal diabetic foot ulcers (DFUs) (i.e., non-responsive over four weeks). Method: This multicentre, open-label, community-based randomised clinical trial compared standard care (SOC) with or without continuous topical oxygen therapy (TOT) for 12 weeks in patients with DFUs or minor amputation wounds. SOC included debridement, offloading with total contact casting (TCC) and appropriate moisture balance. Primary endpoints were the number of patients to achieve complete wound closure and percentage change in ulcer size. Secondary endpoints were pain levels and adverse events. Results: For the study, 145 patients were randomised with index ulcers graded Infectious Diseases Society of America (IDSA) 1 or 2, or Wagner 1 or 2. In the intention-to-treat analysis, 18/64 (28.1%) patients healed in the SOC group at 12 weeks compared with 36/81 (44.4%) in the SOC plus TOT group (p=0.044). There was a statistically significant reduction in wound area between the groups: SOC group mean reduction: 40% (standard deviation (SD) 72.1); SOC plus TOT group mean reduction: 70% (SD 45.5); per protocol p=0.005). There were no significant differences in changes to pain levels or adverse events. Conclusion: This study suggests that the addition of TOT to SOC facilitates wound closure in patients with hard-to-heal DFUs.

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Understanding the relationship between depression and diabetic foot ulcers

Journal of Social Health and Diabetes ◽

10.4103/2321-0656.164792 ◽

2016 ◽

Vol 04 (01) ◽

pp. 017-024 ◽

Cited By ~ 3

Author(s):

Andrew Steel ◽

John Reece ◽

Anne-Marie Daw

Keyword(s):

Depressive Symptoms ◽

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Biological Relationship ◽

The Cost ◽

The Impact ◽

Concept Review ◽

The Relationship

AbstractThe prevalence of diabetes is increasing, as is the cost of managing its comorbidities. Diabetic foot ulcers (DFUs) and their complications place a considerable cost burden on the health system, and lead to a significant level of disability. The relationship between depression and diabetes is well-established. The relationship between depression and foot ulcers in diabetic patients is less well-established. The purpose of this article is to provide a current concept review of the literature from 1988 to 2013, linking DFUs and depressive symptoms, with an emphasis on the impact depressive symptoms have on healing rates of DFUs. Articles specifically focusing on the biological relationship, depression′s impact on self-care, screening for depressive symptoms, causes and cost of treating DFUs, and measuring depression were reviewed. A deeper understanding of this relationship is needed to identify causal relationships, improve treatment outcomes, and reduce healing times of DFUs.

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