Gilligan AM, Waycaster CR, Landsman AL, et al.
Journal of wound care. Date of publication 2015 Mar 1;volume 24(3):149-56.
1. J Wound Care. 2015 Mar;24(3):149-56. doi: 10.12968/jowc.2015.24.3.149.
Wound closure in patients with DFU: a cost-effectiveness analysis of two
cellular/tissue-derived products.
Gilligan AM(1), Waycaster CR, Landsman AL.
Author information:
(1)Manager, Health Economics and Outcomes Research, Adjunct Assistant Professor,
Smith & Nephew Inc., Fort Worth, TX.
OBJECTIVE: Determine the cost-effectiveness of extracellular matrix (ECM)
relative to human fibroblast-derived dermal substitute (HFDS) on diabetic foot
ulcer (DFU) wound closure.
METHOD: Outcomes data were obtained from a 12-week, randomised, clinical trial of
adults aged 18 years or older diagnosed with type 1 or type 2 diabetes with a
DFU. Patients were treated with either ECM or HFDS treatment. A two-state Markov
model (healed and unhealed) with a 1-week cycle length was developed using
wound-closure rates from the trial to estimate the number of closed-wound weeks
and the expected DFU cost per patient. Results were recorded over 12 weeks to
estimate the number of closed-wound weeks per treatment and the average cost to
achieve epithelialisation (primary outcome). The perspective of the analysis was
that of the payer, specifically the Centers for Medicare and Medicaid Services.
No cost discounting was performed because of the short duration of the study.
RESULTS: The study consisted of 26 patients, with 13 in each group. In the ECM
group, 10 wounds closed (77%), with an average closure time of 36 days; 11 wounds
closed in the HFDS group (85%), with an average closure time of 41 days. There
was no significant difference between these results (p=0.73). Over 12 weeks, the
expected cost per DFU was $2522 (£1634) for ECM and $3889 (£2524) for HFDS.
Patients treated with HFDS incurred total treatment costs that were approximately
54% higher than those treated with ECM. Sensitivity analyses revealed that the
total cost of care for two applications of HFDS was more costly than eight
applications of ECM by approximately $500 (£325).
CONCLUSION: In patients with DFU, ECM yielded similar clinical outcomes to HFDS
but at a lower cost. Health-care providers should consider ECM as a cost-saving
alternative to HFDS.
DECLARATION OF INTEREST: A.M. Gilligan, and C.R. Waycaster, are employees of
Smith & Nephew Inc.. This study was funded by Smith & Nephew Inc.. A.L. Landsman,
reports no conflicts of interest.
DOI: 10.12968/jowc.2015.24.3.149
PMID: 25764960 [Indexed for MEDLINE]
