Appendices R1 R2 R3 R4 R5 R6 R7 R8 R9

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2 Appendices Appendix A Characteristics of care by diabetes care group Managed Protocolized Usual Organisation care care care Senior leader Systematic quality check on different levels Incentives for improving quality of care Facilitating care coordination Delivery system change Defined roles and tasks among team members Planned interaction to support evidencebased care Clinical case management service for complex patients Regular followup Patient tailored education and information Decision support Evidence based guidelines Patient empowerment and selfmanagement support Proven education methods Specialist expertise Clinical information system Timely reminders providers and patients Care planning Systematic monitoring patient outcomes Systematic monitoring providers process outcomes Selfmanagement support Discussing care plan with patient Goal setting, cognitive behaviour change strategies Community Encourage patients to participate in community programs A

3 Appendix B Costs prices used for valuing resources or absenteeism (08) Costs Direct health care costs Primary care physician (per visit).89 Diabetes nurse (per visit). Dietician (per visit). Podiatrist (per visit) Pedicure (per visit).50 Physical therapist (per visit).65 Home care (per hour). Specialists (internal medicine, ophthalmology, cardiology, neurology, nephrology, other) (per visit) Psychologist (per visit) Specialist in mental health care (per visit) Blood sample (per sample). Urine sample (per sample).44 Hospitalization (per day) 5. Costs Diabetes Care System (per three months) 83. Direct nonhealth care costs (per hour) Alternative therapists (acupuncturist, homeopath, chiropractors, other) (per visit).63 to 50. Indirect costs (per hour) Absenteeism paid work (per hour).91 Absenteeism unpaid work (per hour) 8.99 Unable to perform usual activities (per hour) 8.99 Hakkaartvan Roijen, L., Tan, S. S., and Bouwmans, C. A. M. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. College voor zorgverzekeringen. Geactualiseerde versie.. [Dutch manual for costing in economic evaluations]. 2

4 Appendix C Transition rates, estimated for each oneyear time step for each of the severity stages distinguished from literature and empirical data 0.09* Table 1: Transition rates between stages of the diabetic foot To Uncomplicated Neuropathy Abscess Healed Amputation From Uncomplicated (0.0* (HbA 1c /) 5.3 (HbA 1c /) 5.3 Neuropathy Abscess Healed Amputation 1 Table 2: Transition rates between stages of nephropathy To Uncomplicated Microalbuminuria Macroalbuminuria ESRD From Uncomplicated 1 (0.07 * 0.07 * (HbA 1c /) 3. ) (HbA 1c /) 3. Microalbuminuria 1 (0.72* 0.72* (HbA 1c /) 7.95 ) (HbA 1c /) 7.95 Macroalbuminuria Diabetes: duration (years) ESRD 1 ESRD=end stage renal disease A

5 Table 3: Transition rates between stages of retinopathy From To Uncomplicated BDR PDR Macular edema Blindness 0.073*(HbA 1c 0.1*(HbA 1c 0.1*(HbA 1c 0.1*(HbA 1c 1(0.073*(HbA 1c 1(0.1*(HbA 1c 1(0.1*(HbA 1c 1(0.1*(HbA 1c Uncomplicated Diabetes duration: 59 (years) *(HbA 1c 0.095*(HbA 1c 0.092*(HbA 1c 0.08*(HbA 1c.00*(HbA 1c /) *(HbA 1c /) *(HbA 1c 0.009*(HbA 1c /) *(HbA 1c /) *(HbA 1c /) 6. BDR Diabetes duration: 59 (years) PDR treated untreated Macular edema treated untreated Blindness 1 BDR= Background diabetic retinopathy, PDR= Proliferative diabetic retinopathy 4

6 Table 4: Variance of probabilities used for the probabilistic sensitivity analyses (PSA). Transition Coefficients of variance Reference Diabetic foot Uncomplicated à neuropathy 0. (1) Neuropathy à abscess 0. (2,3) Abscess à amputation 0. (1,2,4) Uncomplicated à healed 0. (2,5) Neuropathy à healed 0. (2,4,6) Healed à abscess 0.04 (2,3) Abscess à healed 0. (2,4) Retinopathy Uncomplicated à background retinopathy 0. (7) Background retinopathy à proliferative retinopathy 0. (7) Background retinopathy à macular edema 0. (8) proliferative retinopathy à blindness 0.06 (9) macular edema à blindness 0.06 (9) Nephropathy Uncomplicated à microalbuminuria 0. () Microalbuminuria à macroalbuminuria 0. () Macroalbuminuria à End Stage Renal Disease 0. () A

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