Waycaster C, Milne CT, et al.
Journal of medical economics. Date of publication 2013 Jul 1;volume 16(7):976-86.
1. J Med Econ. 2013 Jul;16(7):976-86. doi: 10.3111/13696998.2013.807268. Epub 2013
Jun 7.
Clinical and economic benefit of enzymatic debridement of pressure ulcers
compared to autolytic debridement with a hydrogel dressing.
Waycaster C(1), Milne CT.
Author information:
(1)Healthpoint Biotherapeutics, Fort Worth, TX 76107, USA.
curtis.waycaster@healthpoint.com
OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of
enzymatic debridement using collagenase relative to autolytic debridement with a
hydrogel dressing for the treatment of pressure ulcers.
METHODS: A 3-stage Markov model was used to determine the expected costs and
outcomes of wound care for collagenase and hydrogel dressings. Outcome data used
in the analysis were taken from a randomized clinical trial that directly
compared collagenase and hydrogel dressings. The primary outcome in the clinical
trial was the proportion of patients achieving a closed epithelialized wound.
Transition probabilities for the Markov states were estimated from the clinical
trial. A 1-year time horizon was used to determine the expected number of closed
wound days and the expected costs for the two alternative debridement therapies.
Resource utilization was based on the wound care treatment regimen used in the
clinical trial. Resource costs were derived from standard cost references and
medical supply wholesalers. The economic perspective taken was that of the
long-term care facility. No cost discounting was performed due to the short time
horizon of the analysis. A deterministic sensitivity analysis was conducted to
analyze economic uncertainty.
RESULTS: The number of expected wound days for the collagenase and hydrogel
cohorts are estimated at 48 and 147, respectively. The expected direct cost per
patient for pressure ulcer care was $2003 for collagenase and $5480 for hydrogel
debridement. The number of closed wound days was 1.5-times higher for collagenase
(317 vs 218 days) than with the hydrogel. The estimated cost/closed wound day was
4-times higher for the hydrogel ($25) vs collagenase ($6).
CONCLUSIONS: In this Markov model based on a randomized trial of pressure ulcer
care in a long-term care setting collagenase debridement was economically
dominant over autolytic debridement, yielding better outcomes at a lower total
cost. Since it was a single institution study with a small sample size, the
results should be interpreted with caution. Specifically, the findings may not
necessarily be generalized to other hydrogel dressings, healthcare settings, age
groups, or to wounds of other etiologies.
DOI: 10.3111/13696998.2013.807268
PMID: 23701261 [Indexed for MEDLINE]
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