Entwicklung eines Markov-Modells zur Evaluation therapeutischer Maßnahmen in der Therapie des diabetischen Fußsyndroms aus ökonomischer Sicht

The diabetic foot is one of the most frequent late complications in patients with diabetes mellitus. Its frequency, the substantial cost of treatment and in particular the serious consequences of inadequate treatment, such as amputations and death, place an enormous financial burden on society. Existing treatment guidelines are capable of reducing the incidence of these severe consequences, but are seldom adopted, particularly in the primary care sector and in non-specialist facilities. Establishment of specialist facilities is not encouraged as the financial implications of improved treatment are not known. Data on hospital costs for treating diabetic foot syndrome have not been collected in Austria to date. In this paper, the costs of treating the disease in Austria have been assessed for the first time, using the bottom-up method, and the medium and long-term implications of intensive foot treatment compared to conventional treatment have been calculated prospectively on the basis of a Markov model. The results assist with strategic decision-making on the options available for establishing treatment structures and provide information on the anticipated medical and financial benefits.

The modelling was used to show that more intensive treatment strategies need not invariably involve higher costs and that the initial investment in the establishment of foot health outpatient services is a good idea in every respect. Without this modelling capability, it would only be possible to make these statements after many years of randomised studies for which few resources are available. This dissertation also shows that prospective model-based analyses in medicine are useful alternatives to time-consuming and costly clinical studies.