Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study

Dured Dardari; Sylvia Franc; Guillaume Charpentier; Laurent Orlando; Elise Bobony; Marie Bouly; Ilham Xhaard; Zohra Amrous; Khadijatou Ly Sall; Bruno Detournay; Alfred Penfornis

doi:10.1016/j.lanepe.2023.100686

Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study

Lancet Reg Health Eur. 2023 Jul 16:32:100686. doi: 10.1016/j.lanepe.2023.100686. eCollection 2023 Sep.

Authors

Dured Dardari^{1

2}, Sylvia Franc^{1

3}, Guillaume Charpentier³, Laurent Orlando³, Elise Bobony³, Marie Bouly¹, Ilham Xhaard³, Zohra Amrous³, Khadijatou Ly Sall^{1

3}, Bruno Detournay⁴, Alfred Penfornis^{1

5}

Affiliations

¹ Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France.
² LBEPS, Université d'Evry, IRBA, Université de Paris-Saclay, Evry, France.
³ CERITD (Centre d'Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France.
⁴ CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France.
⁵ Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France.

Abstract

Background: Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial).

Methods: Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed.

Findings: In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population.

Interpretation: The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings.

Funding: This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.

Keywords: Clinical trial; Diabetes; Diabetes complications; Diabetic foot ulcer; Expert nurse; Health cost; Hospitalization; Telehealth; Telemedicine.