Cost-Effectiveness of Three Adjunct Cellular/Tissue-Derived Products Used in the Management of Chronic Venous Leg Ulcers

• Published in: Value in health 2014-12, Vol.17 (8), p.801-813
• Main Authors: Carter, Marissa J., PhD, MA, Waycaster, Curtis, PhD, Schaum, Kathleen, MS, Gilligan, Adrienne M., PhD
• Format: Article
• Language: English
• Subjects: adjunct therapy; Biological and medical sciences; Chronic Disease; Coated Materials, Biocompatible - economics; Compression Bandages - economics; compression therapy; Cost-Benefit Analysis; cost-effectiveness; Extracellular Matrix; General aspects; healing trajectory; Humans; Internal Medicine; Leg Ulcer - economics; Leg Ulcer - therapy; living skin equivalent; Markov Chains; Medical sciences; Miscellaneous; Models, Economic; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Skin, Artificial - economics; small intestinal submucosa; ulcer recurrence; Varicose Ulcer - economics; Varicose Ulcer - therapy; venous leg ulcers; Wound Healing
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2014.08.001

Abstract Objectives Determine the cost-effectiveness of three topically applied cellular/tissue-derived products (CTPs) used as adjunct therapies to standard care in the management of venous leg ulcers (VLUs). Methods A three-state Markov model derived from the medical literature was developed to estimate the comparative cost-effectiveness of three CTPs in relation to VLU standard care. CTPs evaluated in the study included extracellular matrix (ECM), human skin equivalent (HSE), and living skin equivalent (LSE). The three Markov states included unhealed, healed, and death. A 1-year time horizon was used to determine the number of ulcer-free weeks and the expected costs of therapies. The payer perspective was taken in the analysis and only the direct costs of care were considered. Sensitivity analyses were performed to gauge model parameter uncertainty. Results The expected costs for standard care, ECM, HSE, and LSE VLU therapy were $6,132, $6,732, $10,638, and $11,237, while the expected outcomes were 24, 31, 29, and 27 ulcer-free weeks, respectively. ECM was economically dominant among the three CTPs. In the base case of ECM versus standard care, the incremental cost-effectiveness ratio for ECM therapy was $86 per ulcer-free week. Sensitivity analysis did not alter ECM dominance. Clinic visits and home health utilization exhibited the greatest influence on cost. Conclusions ECM is the most cost-effective CTP when used in the management of VLUs as an adjunct to standard care. These findings suggest that VLU standard care therapy with ECM can yield potential cost savings and produce better outcomes than do other CTPs.