Presentation (CTI)

OBJECTIVES: Diabetic foot ulcers (DFU) are a leading cause of lower-limb amputation and impose a substantial burden on Swiss mandatory health insurance (OKP). Transcutaneous carbon dioxide (CO₂) therapy is an outpatient, nurse-administered adjunct that enhances microcirculation and wound healing. We evaluated the cost-effectiveness of CO₂ therapy added to standard of care (SoC) versus SoC alone for DFU from the Swiss payer perspective.
METHODS: A decision-analytic model simulated DFU management over a 12-month horizon. Effectiveness was derived from a multicenter randomized controlled trial (n=115) reporting complete healing at 4 weeks of 64.5% with CO₂ therapy plus SoC versus 7.7% with SoC alone. Swiss unit costs (CHF, 2026) covered the 20-session CO₂ course, weekly wound management, and lower-extremity amputation, with amputation risk conditioned on non-healing. Outcomes were the incremental cost per additional ulcer healed at 4 weeks and total 12-month cost per patient. Deterministic sensitivity analyses tested cost and risk assumptions.
RESULTS: CO₂ therapy increased 4-week healing by 56.8 percentage points, yielding an incremental cost of approximately CHF 3,700 per additional ulcer healed. Over 12 months, CO₂ therapy plus SoC was less costly than SoC alone (CHF 6,592 vs CHF 10,522 per patient), a saving of about CHF 3,900 per patient, while avoiding an estimated 6 amputations per 100 patients treated. CO₂ therapy was therefore dominant—more effective and cost-saving. Dominance was robust in sensitivity analyses, persisting even when amputation costs were excluded entirely (CHF 4,462 vs CHF 4,984 per patient).
CONCLUSIONS: From the Swiss payer perspective, adding transcutaneous CO₂ therapy to standard of care for DFU may accelerate healing, prevent amputations, and reduce 12-month costs. These findings support further Swiss real-world evidence generation and reimbursement evaluation, including coverage with evidence development.