Every so often a study lands that takes something we have felt in our bones for years and stamps a hard number on it. This one does exactly that — and the number is roughly eight to one.
Son Nghiem, Pete Lazzarini, Lauren Ward and a deep bench of colleagues across Queensland asked a deceptively simple question: if you spend money to get people with diabetes-related foot disease into specialist foot care faster, does it actually pay off? Their answer, published in Diabetic Medicine, is a resounding yes.
The setup: in 2018 the Queensland Department of Health invested an extra ~$AU4.7 million a year to incentivise earlier access — getting newly referred patients seen within two days — to its existing network of ambulatory diabetic foot services. The team then compared 830 people who received usual access (controls) with 857 who came through under the new earlier-access model (intervention), drawing on prospectively collected, individually linked real-world data and a Bayesian Markov model run over a five-year horizon.
The payoff: a lower projected probability of hospitalisation, especially after about 20 months; reduced costs of roughly $AU8,429 per person; a gain of 0.06 QALYs per person; and the headline — every $AU1 invested returned $AU7.86 (call it eight-to-one), with a 93.5% probability of being cost-effective.
What I love about this one is that it is not a model built on borrowed assumptions and expert hunches. It is real money, spent in the real world, on real patients, measured against what actually happened to them. And the intervention did not simply win on cost or win on quality of life — it dominated, coming out ahead on both at once. In health economics that is the rare and lovely quadrant, and it is worth saying out loud.
The lesson is the one we keep relearning: speed is therapy. Getting the right foot in front of the right team faster bends the whole trajectory away from infection, hospitalisation and amputation — and it does so while saving the system money. When access and prevention pay an eight-to-one dividend, the question stops being “can we afford to invest in diabetic foot services?” and becomes “how can we possibly afford not to?”
Congratulations to Son Nghiem, Pete Lazzarini, Lauren Ward, Joshua Byrnes and the entire Queensland team. This is the kind of evidence that lets us walk into a health minister’s office and make the case with a straight face and a spreadsheet.
Read the open-access paper here: https://doi.org/10.1111/dme.70373
#DiabeticFoot #DiabeticFootUlcer #AmputationPrevention #CostEffectiveness #HealthEconomics #ToeAndFlow #ValueBasedCare #DiabeticFootServices #ReturnOnInvestment #Diabetes
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