Issue 168 Item 12 Predicted Costs and Outcomes From Reduced Vibration Detection

Treating early and reducing risk of ulceration and amputation, could save U.S. health care payers up to $11.8 billion and save 333,000 life-years and 428,000 QALYs

The ability to perceive vibration (vibration detection) has been shown to be a good predictor of the long-term complications of diabetic peripheral neuropathy (DPN). We aimed to estimate the predicted complications and costs for the U.S. health care system associated with reduced vibration detection (vibration perception threshold 25 V), estimated using a quantitative sensory testing device.

A Markov model was constructed for a hypothetical cohort of people with DPN. The model was run over a 10-year period using Monte Carlo simulations to estimate disease progression, predicted costs, and complications according to vibration detection levels.

The results showed that the average individual with reduced vibration detection incurs approximately five times more direct medical costs for foot ulcer and amputations, yields 0.18 fewer quality-adjusted life-years, and lives for 2 months less than an average individual with normal vibration detection.

From the results it was concluded that the treatment of diabetic foot ulceration and amputation is time-consuming and expensive yet, if appropriate at-risk groups could be identified by the use of VPT, resources could be concentrated on those patients. This could potentially save valuable resources and improve health outcomes. A recent study (35) showed that compliance with a preventative foot care program reduced the incidence of foot ulceration in individuals with reduced vibration detection. If all individuals with reduced vibration detection were identified and some new preventative strategy was available that reduced their risk of ulceration and amputation to levels experienced by those with normal vibration detection, this could save U.S. health care payers up to $11.8 billion and save 333,000 life-years and 428,000 QALYs (discounted) over the next 10 years. Diabetes Care 26:2305-2310, 2003