Tibial nerve decompression for the prevention of the diabetic foot: a cost-utility analysis using Markov model simulations.

Objective: To determine whether tibial neurolysis performed as a surgical intervention for patients with diabetic neuropathy and superimposed tibial nerve compression in the prevention of the diabetic foot is cost effective when compared to the current prevention program.

Design: A baseline analysis was built on a five-year model to determine the cumulative incidence of foot ulcers and amputations with each strategy. Subsequently, a cost-effectiveness analysis and cohort-level Markov simulations were conducted with a model composed of 20 six-month cycles. A sensitivity analysis was also performed.

Setting: A Markov model was used to simulate the effects of standard prevention compared to tibial neurolysis on the long-term costs associated with foot ulcers and amputations. This model included eight health states.

Participants: Each cohort includes simulated patients with diabetic neuropathy at different levels of risk of developing foot ulcers and amputations.

Primary and sec...