Health Quality Ontario. 2017
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Health Quality Ontario. Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment. Ont Health Technol Assess Ser. 2017 Sep 21;17(12):1-124.
Design: Health Technology Assessment Methods: Searches to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. Outcomes included: Cost-effectiveness, 5-year budget impact analysis, qualitative interviews on treatment choices. Results: • 13 RCTs were included in the analysis. • Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence) and irremovable cast walkers (low quality evidence). • No difference in ulcer healing between total contact casting and irremovable cast walkers • The economic analysis showed that total contact casting and irremovable cast walkers were less expensive and led to more health outcome gains than removable cast walkers. • Irremovable cast walkers were as effective as total contact casting and were associated with lower costs. • Patients felt that total contact casting was more effective but removable cast walkers were more convenient and came with a lower cost burden.
Key message: Total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Offloading devices could result in cost- savings in the future.
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