Cost‐effectiveness of investing in earlier access to diabetic foot services: A multi‐centre pre‐post study

AIMS: We evaluated the cost-effectiveness of implementing a novel funding model to incentivise earlier access of patients with diabetes-related foot disease (DFD) to diabetic foot services (DFS). METHODS: In this multi-centre pre-post study, we compared the cost, quality-adjusted life year (QALY) and clinical outcomes of patients with diabetes-related foot disease who had usual access to ambulatory DFS (controls) to patients who accessed the new DFS (intervention) across 15 regions in Queensland, Australia. A generalised linear model was used to estimate the difference in controls and intervention group outcomes, and a Bayesian Markov model estimated transition probabilities between seven health states over a 5-year time horizon from an Australian health service perspective. RESULTS: Overall, 1687 patients were included (830 control, 857 intervention). Compared to controls, the intervention group had a lower projected probability of hospitalisation, particularly after 20 months. The intervention also had reduced costs (-8429 95% confidence intervals: -8461, -8397) and increased QALYs (0. 06 0. 05, 0. 07) compared to controls. On average, AU1 invested in the intervention generated a return of AU7. 86 7. 63, 8. 09. CONCLUSIONS: We found investing in earlier access to DFS to be cost-effective and generated considerably improved patient outcomes, cost savings, and return on investment.