Pharmacoeconomic Analysis of Guidelines for Treating Mild Diabetic Foot Infections: A Decision-Tree Model for Canada
Bibliographic record
Abstract
ABSTRACT Background: Foot infections represent a serious complication of diabetes and are associated with substantial morbidity, health care costs, and risk of death. However, limited information exists to guide clinicians in selecting antibiotics to treat such infections. Objectives: To determine, from the perspective of Ontario’s provincial ministry of health, the cost-effectiveness of treatments recommended by the Infectious Diseases Society of America for mild diabetic foot infections. Methods: A decision-tree model was developed using commercial software. Probabilities of success were derived from published randomized controlled trials. Drug costs were determined from the 2007 Ontario Drug Benefit Formulary and McKesson Canada (a logistics and distribution company in the health care sector), amputation costs from the Canadian Institute for Health Information database for fiscal year 2002/2003, and hospital costs from Sunnybrook Health Science Centre’s 2003/2004 database. All values were adjusted to 2007 dollars using the Canadian Consumer Price Index. Results: The quality of evidence used in the model was weak, and success rates were based on small studies. Expected success rates were 99.4% for clindamycin, 97.8% for cephalexin, 95.4% for amoxicillin–clavulanate, 95.2% for cloxacillin, and 95.0% for levofloxacin. The expected cost for clindamycin was $361.33 per treatment, which was substantially lower than the next best alternative, cephalexin ($1239.99); the cost difference was $878.66 per successful treatment. In this model, clindamycin was the most cost-effective drug, dominating all other choices. In sensitivity analyses, the decision tree model was sensitive to changes in efficacy rates but not changes in cost. Conclusions: In this cost-effectiveness model, clindamycin dominated other oral antibiotics for the treatment of mild diabetic foot infections. However, this observation should be interpreted with caution because the model was based on evidence from relatively few studies with small sample sizes. RESUME Contexte : Les infections du pied representent de serieuses complications du diabete et sont associees a une morbidite, a des couts de sante et a un risque de mortalite considerables. Or, les cliniciens ont acces a tres peu d’information pour les guider dans le choix des antibiotiques pour traiter ces infections. Objectifs : Determiner, du point de vue du ministere de la Sante de l’Ontario, le rapport cout-efficacite des traitements recommandes par l’Infectious Diseases Society of America contre les infections legeres du pied diabetique. Methodes : Un modele d’arbre decisionnel a ete mis au point a l’aide d’un progiciel. Les probabilites de reussite du traitement ont ete derivees de resultats d’essais cliniques comparatifs aleatoires. Les couts des medicaments ont ete determines a partir de la liste de medicaments de 2007 du Programme de medicaments de l’Ontario et de McKesson Canada (une entreprise de logistique et de distribution dans le domaine des soins de sante), les couts d’amputation a partir de la base de donnees de l’Institut canadien d’information sur la sante pour l’exercice financier 2002-2003, et les couts hospitaliers a partir de la base de donnees de 2003-2004 du Sunnybrook Health Science Centre. Toutes les valeurs ont ete converties en dollars de 2007 sur la base de l’indice canadien des prix a la consommation. Resultats : Les donnees probantes utilisees dans le modele etaient de pietre qualite, et les taux de reussite etaient bases sur de petites etudes. Les taux de reussite attendus etaient de 99,4 % pour la clindamycine, de 97,8 % pour la cephalexine, de 95,4 % pour l’amoxicilline–clavulanate, de 95,2 % pour la cloxacilline et de 95,0 % pour la levofloxacine. Les couts prevus pour la clindamycine etaient de 361,33 $ par traitement, ce qui etait considerablement inferieur au cout de la deuxieme meilleure option, la cephalexine (1239,99 $); la difference de cout par traitement reussi etait de 878,66 $. Dans ce modele, la clindamycine avait un rapport cout-efficacite favorable, surpassant toutes les autres options. Les analyses de sensibilite ont revele que le modele d’arbre decisionnel etait sensible aux changements dans les taux d’efficacite, mais non aux changements de couts. Conclusions : Dans ce modele d’analyse cout-efficacite, la clindamycine a surpasse d’autres antibiotiques par voie orale dans le traitement des infections legeres du pied diabetique. Cependant, il faut interpreter cette observation avec prudence, car le modele etait base sur des donnees issues d’un nombre relativement limite d’etudes assorties de petits echantillons.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".