Data from: 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 secondary outcome
measures: The primary outcome was the long-term trends concerning the
development of ulcers and amputations with each strategy. The secondary
outcome measures were quality adjusted life years (QALYs); incremental
cost-effectiveness; and net monetary benefits of the optimal strategy.
Results: When compared to standard prevention, for a patient population of
10,000, surgery prevented a simulated total of 1,447 ulcers and 409
amputations over a period of 5 years. In a subsequent analysis that
consisted of 20 six-month cycles (10 years), the incremental cost of
tibial neurolysis compared to current prevention was $12,772.28; the
incremental effectiveness was 0.41 QALYs; and the incremental
cost-effectiveness ratio (ICER) was $31,330.78. Survival was 73% for those
receiving medical prevention compared to 95% for those undergoing surgery.
Conclusion: These results suggest that among patients with diabetic
neuropathy and superimposed nerve compression, surgery is more effective
at preventing serious comorbidities and is associated with a higher
survival over time. It also generated greater long-term economic benefits.