Guest JF, Weidlich D, Singh H, La Fontaine J, Garrett A, Abularrage CJ, Waycaster CR, et al.
Journal of wound care. Date of publication 2017 Jan 2;volume 26(Sup1):S12-S24.
1. J Wound Care. 2017 Jan 2;26(Sup1):S12-S24. doi: 10.12968/jowc.2017.26.Sup1.S12.
Cost-effectiveness of using adjunctive porcine small intestine submucosa
tri-layer matrix compared with standard care in managing diabetic foot ulcers in
the US.
Guest JF(1), Weidlich D(2), Singh H(2), La Fontaine J(3), Garrett A(4),
Abularrage CJ(5), Waycaster CR(6).
Author information:
(1)Director of Catalyst, Visiting Professor of Health Economics, Catalyst Health
Economics Consultants, Northwood, Middlesex, UK; and Faculty of Life Sciences and
Medicine, King's College, London, UK.
(2)Health Economist, Catalyst Health Economics Consultants, Northwood, Middlesex,
UK.
(3)Professor of Plastic Surgery; University of Texas, Southwestern Medical
Center, Dallas, TX, US.
(4)Assistant Professor, Ben Hogan Bone & Joint Clinic, Fort Worth, TX, US.
(5)Associate Professor of Surgery, Director, Multidisciplinary Diabetic Foot &
Wound Clinic, Diabetic Foot & Wound Clinic, The Johns Hopkins Hospital,
Baltimore, MD, US.
(6)Director, Health Economics, Smith & Nephew Biotherapeutics, Fort Worth, TX,
US.
OBJECTIVE: To estimate the cost-effectiveness of using tri-layer porcine small
intestine submucosa (SIS; Oasis Ultra) as an adjunct to standard care compared
with standard care alone in managing diabetic foot ulcers (DFUs) in the US, from
the perspective of Medicare.
METHOD: A Markov model was constructed to simulate the management of diabetic
neuropathic lower extremity ulcers over a period of one year in the US. The model
was used to estimate the cost-effectiveness of initially using adjunctive SIS
compared with standard care alone to treat a DFU in the US at 2016 prices.
RESULTS: At 12 months after the start of treatment, the use of adjunctive SIS
instead of standard care alone is expected to lead to a 42 % increase in the
number of ulcer-free months, 32 % increase in the probability of healing, a 3 %
decrease in the probability of developing complicated ulcers and a 1 % decrease
in the probability of undergoing an amputation. Health-care resource use is
expected to be reduced by 11-14 % among patients who are initially managed with
adjunctive SIS compared with those initially managed with standard care alone,
with the exception of debridement, which is expected to be reduced by 35 %.
Hence, the total health-care cost of starting treatment with adjunctive SIS
instead of standard care alone was estimated to reduce payer costs by 1% (i.e.
$105 per patient) over 12 months following the start of treatment.
CONCLUSION: Within the study's limitations, the use of adjunctive SIS instead of
standard care alone improves outcome for less cost and thereby affords a
cost-effective use of Medicare-funded resources in the management of neuropathic
foot ulcers among adult patients with type 1 or 2 diabetes mellitus in the US.
DOI: 10.12968/jowc.2017.26.Sup1.S12
PMID: 28105902
