On the decision rules of cost-effective treatment for patients with diabetic foot syndrome

John E Goulionis¹, Athanassios Vozikis², VK Benos¹, D Nikolakis<sup>1

1</sup>Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece; ²Department of Economic Science, University of Piraeus, Piraeus, Greece

Objective: To assess the cost-effectiveness of two treatments (medical treatment and ­amputation) in patients with diabetic foot syndrome, one of the most disabling diabetic complications. Diabetes mellitus is a massive health care problem worldwide with a current prevalence of 150 millions diabetic cases, estimated to increase to 300 million cases in 2025.

Methods: Integrating medical knowledge and advances into the clinical setting is often difficult due to the complexity of the algorithms and protocols. Clinical decision support systems assist the clinician in applying new information to patient care through the analysis of patient-specific clinical variables. We require strategic decision support to analyze the cost-effectiveness of these programs compared to the status quo. We provide a simple partially observable Markov model to investigate that issue, and we propose an heuristic algorithm to find the best policy of intervention.

Results: This study assesses the potential cost-effectiveness of two alternative treatment interventions in patients with diabetic foot syndrome. The implementation of the heuristic algorithm solution will assist doctors in clinical decision making, and health care organizations in evaluating medication choices for effective treatment. Finally, our study reveals that treatment programs are highly cost-effective for patients at high risk of diabetic foot ulcers and lower extremity amputations.

Keywords: partially observable Markov decision model, diabetic foot syndrome, cost-­effectiveness method