Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy
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To carry out a cost-effectiveness analysis of the use of Neuropad as a screening test for diabetic neuropathy together with the standard care tool, the 10-g monofilament, in people with diabetes.
Research design and methods
A cost-effectiveness analysis using a Markov model was developed to assess the impact on costs and outcomes of using Neuropad as a test for diabetic neuropathy (1) as a complement to the standard test, the 10-g monofilament (Neuropad + monofilament vs. monofilament); and (2) as a substitute for the monofilament (Neuropad vs. monofilament); from the healthcare provider perspective. The time horizon was 3 years. Data on costs and health gains were extracted from the literature. The incremental cost–utility ratio was calculated. Deterministic and probabilistic sensitivity analyses were also performed.
Compared with standard care, Neuropad, in combination with the 10-g monofilament tool, is the dominant strategy as it leads to higher health gains and lower costs. In practice, compared with using the monofilament alone, performing both tests would lead to a savings of £1049.26 per patient and 0.044 QALY gain. Results were found to be consistent across the sensitivity analyses.
Using both screening tools (Neuropad + monofilament) is a cost-effective strategy and the dominant alternative, when compared against using the 10-g monofilament alone. The results would be of special relevance in the early detection of diabetic peripheral neuropathy and to ensure the efficient allocation of resources and, thus, the sustainability of healthcare systems.
KeywordsNeuropad Diabetes Diabetic peripheral neuropathy Cost-effectiveness SWME
JEL ClassificationH00 H5 H51 I00 I1 I10
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We thank the contribution of John Simpson, Peter Altman and Marta Trapero Bertrán, as well as the anonymous referees that have reviewed different versions of this manuscript for their appreciated input to this research paper.
Compliance with ethical standards
Conflicts of interest
No potential conflicts of interest relevant to this article were reported.
- 1.Diabetes UK.: Facts and Stats from https://diabetes-resourcesproduction.s3euwest1.amazonaws.com/diabetesstorage/migration/pdf/DiabetesUK_Facts_Stats_Oct16.pdf (2016). Accessed 10 Apr 2017
- 3.NIDDKD.: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies (2018). Accessed 7 June 2018
- 6.Ziegler, D.: Diabetic peripheral neuropathy. In: Holt, R.I.G., Cockram, C.S., Flyvbjerg, A., et al. (eds.) Textbook of Diabetes, 4th edn. Wiley-Blackwell, Oxford (2010)Google Scholar
- 7.Kerr, M.: Footcare for people with diabetes: the economic case for change. Insight Health Economics, NHS Diabetes (2012)Google Scholar
- 8.Public Health England.: Diabetes footcare activity profiles. In: Using the Average Annual Number Of amputations Per Year from 2012 to 2015 (2016)Google Scholar
- 9.Public Health England.: Annual Report and Accounts 2014/15 (2015)Google Scholar
- 10.Kerr, M.: Diabetic Foot Care in England: An Economic Study. Insight Health Economics, For Diabetes, London (2017)Google Scholar
- 16.National Institute for Health & Care Excellence.: Diabetic foot problems. Prevention and management. NICE Clinical Guideline No. 19. https://www.nice.org.uk/guidance/ng19/evidence/full-guidance-pdf-15672915543) (2016a). Accessed 5 June 2018
- 18.Kim, C.H., Jeong, S.J., Mok, J.O., Lee, K.Y., Kim, S.R.: Impact on quality of life in peoples with painful diabetic peripheral neuropathy. Endocr. Abstr. 37, EP443 (2015)Google Scholar
- 19.Van Acker, K., Bouhassira, D., De Bacquer, D., Weiss, S., Matthys, K., Raemen, H., Mathieu, C., Colin, I.M.: Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 35(3), 206–213 (2009)CrossRefGoogle Scholar
- 21.Papanas, N., Giassakis, G., Papatheodorou, K., et al.: Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study. J. Diabetes Complicat. 21(6), 353–358 (2007)CrossRefGoogle Scholar
- 22.Papanas, N., Papatheodorou, K., Papazoglou, D., et al.: A comparison of the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes. Exp. Clin. Endocrinol. Diabetes 116(2), 135–138 (2008)CrossRefGoogle Scholar
- 26.Edlin, R., McCabe, C., Hulme, C., Hall, P., Wright, J.: Building a Markov cost effectiveness model in excel. In: Cost Effectiveness Modelling for Health Technology Assessment, 1st edn, pp. 41–57. Adis (2015)Google Scholar
- 27.Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L., Torrance, G.W.: Methods for the Economic Evaluation of Health Care Programmes, 4th edn. Oxford University Press, Oxford (2015)Google Scholar
- 31.National Institute for Health & Care Excellence.: NICE MTEP briefing note—MT318 Neuropad for detecting diabetic foot neuropathy. MT318 Neuropad—MTAC November 2016 (2016b)Google Scholar
- 36.Brigss, A., Claxton, K., Schulper, M.J.: Decision analytic modelling for the evaluation of health technologies. Oxford University Press, Oxford (2006)Google Scholar
- 37.Claxton, K., Martin, S., Soares, M., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P.C., Schulper, M.: Methods for the estimation of the NICE cost effectiveness threshold. CHE research paper 81 (2013)Google Scholar
- 38.British Diabetic Association Good clinical practice guidelines for care home residents with diabetes. A revision document prepared by a Task and Finish Group of Diabetes UK. British Diabetic Association for Diabetes UK (2010)Google Scholar
- 43.Kerr, M., Barron, E., Chadwick, P., Evans, T., Kong, W.M., Rayman, G., Sutton-Smith, M., Todd, G., Young, B., Jeffcoate, W.J.: The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet. Med. 8, 8–9 (2019). https://doi.org/10.1111/dme.13973 CrossRefGoogle Scholar