Diabetic foot ulcers and amputations: estimates of health utility for use in cost-effectiveness analyses of new treatments

Objectives: Diabetic foot ulcers (DFU), infections and amputations are associated with high costs of care and loss of health. To evaluate new treatments, both the extra costs incurred and the health utility gained need to be examined, However, evaluations of treatments in diabetes are hampered by the lack of utility values for health states such as DFU. We estimated utility values for health states seen amongst DFU patients. Methods: We identified 13 unique health states based on presence/type of DFU and amputation. Members of the general public (n = 107) received a description of each health state. They were then asked to indicate how undesirable each health state was (using the time tradeoff method). Each answer was then transformed to create a value representing the "utility" of the health state, the utility value represented on a 0-1 scale. Results: Valid responses could be obtained from 96 persons. Mean values included: 0.84 (diabetes with no DFU or amputation), 0.75 (uninfected DFU, no amputation), 0.68 (no DFU, previous foot amputation), and 0.63 (uninfected DFU, previous amputation of other foot). The impact of an ulcer depended on amputation status. Conclusions: Our values correspond with previously published results but are more detailed. In addition, since our values were derived from the general public, economic evaluations that incorporate them will use the generally preferred societal perspective. Therefore, these values are appropriate, practical and sensitive weights to calculate QALYs for cost-effectiveness analyses of foot ulcer treatments.