Health economic considerations to effectively implement telemonitoring of diabetic foot ulcer #HealthEconomics #DiabeticFootUlcer #ActAgainstAmputation #Lancet

Intriguing work in Lancet Regional Health by Willems

The manuscript by Willems discusses the global prevalence of diabetes, affecting 537 million people, with 45% undiagnosed, and the associated risks of progressing to Type 2 Diabetes Mellitus. Health problems related to diabetes include retinopathy, heart disease, nephropathy, and particularly diabetic foot ulcer (DFU), with a global prevalence of 6.3% among those with diabetes. DFUs pose significant complications, including infection, amputation, and even death.

Diabetes accounts for 11.5% of global health expenditures, with one-third related to DFUs, and hospitalization being the primary cost. The French TELEPIED trial is highlighted, where 180 patients with DFU were randomized into intervention and control groups to assess the impact of telemedicine management versus standard care. The intervention group, who sent weekly pictures of their DFU to a hospital-based nurse, experienced fewer hospitalization days (7.1 days compared to 13.4 days) and reduced costs at 12 months. However, caution is advised in interpreting the results, though the randomization and consistent baseline characteristics lend strength to the hypothesis that TELEPIED lowered costs.

The manuscript also addresses the challenges and considerations related to telemonitoring remuneration, emphasizing the need for fair payment strategies. Several challenges with the fee-for-service system are identified, and alternative or hybrid payment schemes are discussed, with suggestions for more episodic payment for continuous monitoring like DFU telemonitoring.

Lastly, the manuscript emphasizes the importance of conducting thorough health economic evaluations of telemonitoring, including more comprehensive cost components and adherence to the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). The TELEPIED trial’s focus on hospitalization costs is recognized, but it’s stressed that broader economic assessments, including primary care and social impact on patients, should be considered for a more comprehensive understanding.