Hyperbaric oxygen therapy as an adjunct to the standard wound care for the treatment of diabetic foot ulcers in Indian patients: a cost utility analysis

ABSTRACT

Background

Diabetic foot ulcer (DFU) is a common complication of diabetes. Hyperbaric oxygen therapy (HBOT) is an adjunct treatment that expedites the healing of DFU.

Aim

To evaluate the cost-utility of using standard wound care (SWC) plus HBOT as compared to SWC alone for the treatment of DFU from a societal perspective in the Indian context.

Method

A Markov decision analysis model comparing SWC with and without HBOT was developed. Data for the model were derived from relevant literature and secondary data from India. The main outcome measures were minor and major lower extremity amputations (LEA) averted, incremental quality-adjusted-life-years (QALY) gained, incremental costs, incremental cost-effectiveness ratio (ICER) per amputation averted and ICER per QALY gained. Sensitivity and threshold analyses were also done.

Result

HBOT, when added to SWC, lowered the proportion of minor LEA and major LEA among patients with DFU by 6.1% and 4.2%, respectively. The discounted ICER was INR 193,939 [95% CI: 186,745–203,753] or US$ 2,621 [95% CI: 2,524–2,753] per QALY gained.

Conclusion

SWC plus HBOT is not cost-effective in India. Additional information is required on patient experiences with adjunctive HBOT, if it were to be adopted as the standard of care in India.

KEYWORDS:

• Diabetic complications
• economic evaluation
• societal perspective
• Markov model
• India

Acknowledgments

We would like to acknowledge the kind support and encouragement by Dr Rakesh Aggarwal, Director, Jawaharlal Institute of Postgraduate Medical Education and Research for his comments and suggestions to improve the study. We thank anonymous reviewers for their valuable suggestions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FM Thiruvoth - Research Question; S Rajasulochana - First draft of the manuscript, literature review; Model analysis and Revision of the manuscript; S Mathan Kumar - Conceptualization of the model; E Sarvananan - Clinical inputs for the model development; P Sivanantham - Editing of the manuscript & SS Kar - Coordination and supervision of the work. All authors approved the final manuscript to be published.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2022.2085562

Additional information

Funding

This paper was not funded.