Background: This study sought to examine the real-world impact of multimodality cyclical-pressure topical wound oxygen therapy (TWO2) on hospitalizations and amputations in patients with diabetic foot ulcer (DFU) compared with patients without TWO2. Methods: We conducted a retrospective review of deidentified patient medical records at 2 U.S. Veterans Affairs hospitals between January 2012 and January 2020. DFU patients were assigned to TWO2 or NO TWO2 cohorts based on their treatment records. Patients received appropriate standard of care and may have received other advanced wound treatments, including skin substitutes, negative pressure wound therapy, and growth factors. Primary study outcomes were patients requiring hospitalization and/or amputation within 360 days of initial wound documentation. Findings: Among unmatched cohorts of 202 patients with DFU (91 TWO2, 111 NO TWO2), 6.6% and 12.1% of TWO2 patients had hospitalizations and amputations, respectively, compared with 54.1% and 41.4% of NO TWO2 patients within 360 days ( p < 0.0001, p < 0.0001), representing 88% and 71% reductions. Among propensity score-matched cohorts of 140 DFU patients (70 TWO2, 70 NO TWO2), compared with NO TWO2, 82% fewer TWO2 patients were hospitalized (7.1% vs. 40.0%, p < 0.0001) and 73% fewer TWO2 patients had amputations (8.6% vs. 31.4%, p = 0.0007). Logistic regression among matched cohorts demonstrated nearly ninefold and fivefold higher risk of hospitalization and amputation, respectively, for NO TWO2 versus TWO2. Interpretation: This retrospective cohort study demonstrates that treating patients with DFU with TWO2 is associated with significant reductions in hospitalizations and amputations in the real-world setting.

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Objectives: The present study was aimed to investigate the availability and price of essential medicines in both public and private health facilities in Indonesia. Methods: The cross-sectional study was carried out using the World Health Organization (WHO) and Health Action International (HAI) methodology. Availability data for 50 medicines of global, regional, and supplementary list of medicines was collected from six health facilities, consisted of public and private hospitals and retail pharmacies in Yogyakarta region. Medicine price ratios were calculated using international reference prices (IRPs). Results: The mean availability of generic essential medicines in public healthcare facilities and private sectors was 76.6% and 60.58%, respectively. Availability of generic medicines was much higher in the public sector. Four medicines had zero availability were atenolol tablet, enalapril tablet, beclometason inhaler, and clotrimazole topical cream. The procurement price in public sector was 0.98, while in private sector was 2.46 times the IRP. Findings of Median MPR of lowestpriced generic (LPG) in the private sector for ceftriaxone was 5.64, ranitidine was 4.35, and salbutamol was 4.19 times higher than international price. In public health facilities, ceftriaxone injection was 2.19 times compared to international price. Conclusions: This study revealed that availability of essential medicines was inadequate, but procurement prices of surveyed medicines were considered efficient, especially in public sector. However, variation in procurement prices of selected medicines was noted. These evidences impose significant policy implications that could help in formulating policies to optimize the access to essential medicines for patients.