Cost effectiveness of topical wound oxygen therapy for chronic diabetic foot ulcers

Aims: To estimate the cost effectiveness of Topical Wound Oxygen therapy (TWO2) for chronic diabetic foot ulcers. Methods: A Markov model was created to estimate the cost effectiveness of TWO2 over 2 years. Clinical outcome probabilities were estimated from a recent multi-national randomised controlled trial. Diabetic footcare costs were estimated for the National Health Service in England, based on national cost collections, published literature and expert opinion. Model inputs were varied in sensitivity analyses. Results: Base case results indicate that at a weekly TWO2 price of 650 pound for up to 12 weeks, total diabetic footcare costs over 2 years are 5038 pound lower for a patient treated with TWO2 than for standard care, and QALYs are 0.07 higher. Probabilistic sensitivity analysis estimates an 81 % likelihood that the treatment is cost effective at a willingness to pay threshold of 25,000 pound per QALY. Conclusions: Base case results indicate that if the clinical outcomes in the RCT are replicated in routine care, TWO2 is a dominant treatment, with lower cost and improved outcomes relative to standard care. Sensitivity analysis shows a high probability that the treatment is cost effective at a willingness to pay threshold of 25,000 pound per QALY.