OBJECTIVES: The prevalence of diabetic foot ulcers (DFU) is rising fast along with the prevalence of diabetes. As a well-known risk factor of lower extremity amputation, DFU are costly in pecuniary and non-pecuniary means. However, early screenings within low-risk DFU patients are not recommended in clinical guidelines. From a healthcare sector perspective, we sought to find the cost-effectiveness of non-invasive screening tests, ankle-brachial index (ABI) and transcutaneous oxygen measurement (TcPo2), for DFU patients to achieve better clinical outcomes.

METHODS: We used a hybrid model that combined decision tree with Markov modeling to evaluate the cost-effectiveness of ABI and TcPo2 for patients with DFU. The hypothetical cohort aged 66 was evaluated annually until the endpoint. We evaluated costs and quality-adjusted life-years (QALYs) based on the previous studies and further calculated the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) with a $50,000 per QALY baseline willingness-to-pay threshold. We had one-way sensitivity analysis performed and produced tornado diagrams to evaluate the uncertainty of our key parameters. We had probabilistic sensitivity analysis performed and produced ICER planes and cost-effectiveness acceptability curves to summarize the impact of uncertainties on the results.

RESULTS: The average total cost with the ABI screening test to a DFU patient increased by $16,814.01 comparing to the cost of no screening, but patient would gain 0.56 more. The ICER was $30,202.78 per QALY, and the iNMB was $11,021.20. With TcPo2 screening, the average cost increased by $53,479.21 per patient comparing to the cost of no screening, and QALYs increased by 2.18. The ICER was $24,488.24 per QALY, and the iNMB was $55,714.44.

CONCLUSIONS: ABI and TcPo2 were cost-effective using a $50,000 per QALY willingness-to-pay threshold. With a climbing prevalence of diabetic foot ulcers, non-invasive screening tests will become more cost-effective from a health care sector perspective.