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Comparison Home Care Service Versus Hospital-Based Care in Patients With Diabetic Foot Ulcer: An Economic Evaluation Study Publisher



Jafary M1 ; Amini M2 ; Sanjari M2 ; Aalaa M3 ; Goudarzi Z4 ; Najafpour Z5 ; Mohajeri Tehrani M6
Authors
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Authors Affiliations
  1. 1. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Pharmacoeconomics and pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Health care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  6. 6. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Diabetes and Metabolic Disorders Published:2020


Abstract

Introduction: Providing health care to patients at home could be causing the mortality and readmission rates reduction in addition to satisfaction of both patients and health care providers increase. The aim of this study was to assess the cost-effectiveness of home care service compared to hospital based care in patients with diabetic foot ulcer. Methods: An economic evaluation study and a trial study were simultaneously conducted in Iran. In trial phase, patients with diabetic foot ulcer were randomly assigned to the home care or hospital care. The Cost and Quality of life data were determined as measures of the study. Incremental cost-effectiveness ratio was calculated for comparative purposes. The model consisted of five stages of the disease. The Tree Age Pro 2009 and R software’s were used for data analysis. Results: 120 patients were enrolled in our trial; among which 30 patients were in home care service group and 90 patients in hospital based care group. The rate of ulcer size reduction in hospital based care was significant (P value = 0.003) in comparison with home care service. The total cost of the home care and hospital strategies were 1720.4 US$, 3940.3 US$ and the total effectiveness were 0.31 and 0.29, respectively. The incremental cost-effectiveness ratio (ICER) was 117,300 US$ per quality-adjusted life year for home care intervention compared to hospital based care. Based on ICER plane home care treatment will be placed on the southeastern quadrant of the Cost-Effectiveness Plane, and is suggested as a more dominant treatment alternative. Conclusions: Regarding current evidence, home care strategy for patients suffering diabetic foot ulcer enjoys more cost effectiveness compared to hospital care. It is suggested that healthcare policy makers determine the tariff for health care services for disease groups according to the activity based costing approach. © 2020, Springer Nature Switzerland AG.