1. Would the authors please indicate why the particular centres were used in this study.

Did they provide

care to the same community or were they based on other criteria? I note for instance that the travel costs
are more than double for the hospital based service. Is this because the patients had to travel further to
hospital or because of more frequent visits?

Answer :

We added in the methods:

These two hospitals are utilised because they have a wound polyclinic and/or a diabetic foot polyclinic, and
the costs of wound care are paid by BPJS. Aside from that, patients who seek care at private wound clinics
and hospitals share the same criteria with regard to diabetes patients' cases and/or wound conditions.

Regarding the higher cost of transportation in hospitals compared to private clinics, we have added and
incorporated this information into the discussion. As below

Interestingly, our research showed that hospital transportation costs are higher than those of private
clinics. This could be due to the frequency and/or duration of wound care, longer distances, and the
fact that patients continue to choose BPJS-covered wound care services despite their longer
distance from private clinics. Unfortunately, our study did not collect patient income information.
2. It would be helpful to know the total number of days on treatment for each group together with an
estimate of the number of dressing changes (provider contacts) in each group.

3. Please would the authors confirm what "immediate QOL" means. I presume that it means the baseline
score. If this is the case then it is clear that the private facility patients have a much higher health index at
baseline. Moreover, the difference between baseline and median QOL is 0.15 in the private clinic and 0.14
in the hospital service which would show a much smaller benefit of the private clinics than that given by the
current analysis.

4. The wound healing time is given in table 1. Please would the authors confirm what this time means. Is
this from the time of first visit, in which case the ranges are in excess of the 12 week cut off? Moreover, can
I assume that these results that all ulcers healed? How many ulcers healed within the time frame of the
study?

5. I note that the median wound size is 10cm(squared?), but there is a statistical probability of 0.047. Would
the authors please confirm which group had the higher wound size.

6. The numbers in each group are not given explicitly in the results section, though from table 1 it can be
calculated as 42 in private practice and 47 in hospital care. Please provide this information at the start of the
results section and in the abstract.

The authors acknowledge that there are a number of factors that may impact on the cost effectiveness
including the level of expertise of the staff and access to a wider range of dressing materials. This study
provides some evidence on the benefits of the private clinic system, though these potential benefits must
be tempered by the complexity of the systems being assessed and the influence of many known and
unknown factors.

Senior Editor Comments:

Senior Editor

Comments to the Author:

There is some unclearness in this dataset population's selection, demographics, and uniqueness.

1. Mohon penulis menunjukkan mengapa pusat-pusat tertentu digunakan dalam penelitian ini. Apakah
mereka memberikan layanan kepada komunitas yang sama atau berdasarkan kriteria lain? Saya perhatikan
misalnya bahwa biaya perjalanan lebih dari dua kali lipat untuk layanan berbasis rumah sakit. Apakah ini
karena pasien harus menempuh perjalanan jauh ke rumah sakit atau karena kunjungan yang lebih sering?

2. Akan sangat membantu jika mengetahui jumlah hari pengobatan untuk masing-masing kelompok dan
perkiraan jumlah penggantian balutan (kontak penyedia) di setiap kelompok.

3. Mohon penulis mengkonfirmasi apa yang dimaksud dengan "QOL langsung". Saya berasumsi bahwa itu
berarti skor dasar. Jika hal ini terjadi maka jelas bahwa pasien di fasilitas kesehatan swasta memiliki indeks
kesehatan yang jauh lebih tinggi pada awal. Selain itu, perbedaan antara kualitas hidup dasar dan median
adalah 0,15 di klinik swasta dan 0,14 di layanan rumah sakit, yang menunjukkan manfaat yang jauh lebih
kecil dari klinik swasta dibandingkan dengan analisis saat ini.

4. Waktu penyembuhan luka diberikan pada tabel 1. Mohon penulis mengkonfirmasi apa yang dimaksud
dengan waktu tersebut. Apakah ini sejak kunjungan pertama, dalam hal ini rentangnya melebihi batas 12
minggu? Selain itu, apakah saya bisa berasumsi dengan hasil ini semua maag bisa sembuh? Berapa banyak
bisul yang sembuh dalam kurun waktu penelitian?

5. Saya perhatikan bahwa ukuran median luka adalah 10cm (kuadrat?), namun terdapat probabilitas statistik
sebesar 0,047. Mohon penulis mengkonfirmasi kelompok mana yang memiliki ukuran luka lebih tinggi.

6. Jumlah tiap kelompok tidak diberikan secara eksplisit pada bagian hasil, meskipun dari tabel 1 dapat
dihitung 42 pada praktik swasta dan 47 pada perawatan rumah sakit. Harap berikan informasi ini di awal
bagian hasil dan di abstrak.

Para penulis mengakui bahwa ada sejumlah faktor yang mungkin berdampak pada efektivitas biaya
termasuk tingkat keahlian staf dan akses terhadap bahan pembalut yang lebih beragam. Studi ini
memberikan beberapa bukti mengenai manfaat sistem klinik swasta, meskipun potensi manfaat ini harus
dibatasi oleh kompleksitas sistem yang dinilai dan pengaruh dari banyak faktor yang diketahui dan tidak
diketahui.

Komentar Editor Senior:

Editor Senior

Komentar untuk Penulis:

Ada beberapa ketidakjelasan dalam pemilihan, demografi, dan keunikan populasi kumpulan data ini.