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Difficult-to-heal wounds of mixed arterial/venous and venous etiology: a cost-effectiveness analysis of extracellular matrix.

Romanelli M, Gilligan AM, Waycaster CR, Dini V - Clinicoecon Outcomes Res (2016)

Bottom Line: After 8 months, patients treated with ECM had substantially higher closed-wound weeks compared with SC (26.0 weeks versus 22.0 weeks, respectively).ECM yielded better clinical outcomes at a slightly lower cost in patients with mixed A/V and VLUs.ECM is an effective treatment for wound healing and should be considered for use in the management of mixed A/V and VLUs.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Pisa, Pisa, Italy.

ABSTRACT

Importance: Difficult-to-heal wounds pose clinical and economic challenges, and cost-effective treatment options are needed.

Objective: The aim of this study is to determine the cost-effectiveness of extracellular matrix (ECM) relative to standard of care (SC) on wound closure for the treatment of mixed arterial/venous (A/V) or venous leg ulcers (VLUs).

Design setting and participants: A two-stage Markov model was used to predict the expected costs and outcomes of wound closure for ECM and SC. Outcome data used in the analysis were taken from an 8-week randomized clinical trial that directly compared ECM and SC. Patients were followed up for an additional 6 months to assess wound closure. Forty-eight patients completed the study; 25 for ECM and 23 for SC. SC was defined as a standard moist wound dressing. Transition probabilities for the Markov states were estimated from the clinical trial.

Main outcomes and measures: The economic outcome of interest was direct cost per closed-wound week. Resource utilization was based on the treatment regimen used in the clinical trial. Costs were derived from standard cost references. The payer's perspective was taken.

Results: ECM-treated wounds closed, on average, after 5.4 weeks of treatment, compared with 8.3 weeks for SC wounds (P=0.02). Furthermore, complete wound closure was significantly higher in patients treated with ECM (P<0.05), with 20 wounds closed in the ECM group (80%) and 15 wounds closed in the SC group (65%). After 8 months, patients treated with ECM had substantially higher closed-wound weeks compared with SC (26.0 weeks versus 22.0 weeks, respectively). Expected direct costs per patient were $2,527 for ECM and $2,540 for SC (a cost savings of $13).

Conclusion and relevance: ECM yielded better clinical outcomes at a slightly lower cost in patients with mixed A/V and VLUs. ECM is an effective treatment for wound healing and should be considered for use in the management of mixed A/V and VLUs.

No MeSH data available.


Related in: MedlinePlus

Cost-effectiveness acceptability curve by treatment.Abbreviations: ECM, extracellular matrix; SC, standard of care.
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f3-ceor-8-153: Cost-effectiveness acceptability curve by treatment.Abbreviations: ECM, extracellular matrix; SC, standard of care.

Mentions: Probabilistic sensitivity analysis indicated that adjunct ECM had the highest average effectiveness of 26±1.2 closed-wound weeks, whereas SC had the lowest at 22±1.4 closed-wound weeks. The cost-effectiveness acceptability curve (Figure 3) illustrates the probability that any one strategy is cost-effective as a function of willingness to pay. Given a maximum acceptable ceiling ratio of $2,000/closed-wound week, the probability that ECM is cost-effective compared with SC is 95%. If a patient’s willingness to pay is $0, the probability that ECM is cost-effective compared with SC is 53%.


Difficult-to-heal wounds of mixed arterial/venous and venous etiology: a cost-effectiveness analysis of extracellular matrix.

Romanelli M, Gilligan AM, Waycaster CR, Dini V - Clinicoecon Outcomes Res (2016)

Cost-effectiveness acceptability curve by treatment.Abbreviations: ECM, extracellular matrix; SC, standard of care.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862353&req=5

f3-ceor-8-153: Cost-effectiveness acceptability curve by treatment.Abbreviations: ECM, extracellular matrix; SC, standard of care.
Mentions: Probabilistic sensitivity analysis indicated that adjunct ECM had the highest average effectiveness of 26±1.2 closed-wound weeks, whereas SC had the lowest at 22±1.4 closed-wound weeks. The cost-effectiveness acceptability curve (Figure 3) illustrates the probability that any one strategy is cost-effective as a function of willingness to pay. Given a maximum acceptable ceiling ratio of $2,000/closed-wound week, the probability that ECM is cost-effective compared with SC is 95%. If a patient’s willingness to pay is $0, the probability that ECM is cost-effective compared with SC is 53%.

Bottom Line: After 8 months, patients treated with ECM had substantially higher closed-wound weeks compared with SC (26.0 weeks versus 22.0 weeks, respectively).ECM yielded better clinical outcomes at a slightly lower cost in patients with mixed A/V and VLUs.ECM is an effective treatment for wound healing and should be considered for use in the management of mixed A/V and VLUs.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, University of Pisa, Pisa, Italy.

ABSTRACT

Importance: Difficult-to-heal wounds pose clinical and economic challenges, and cost-effective treatment options are needed.

Objective: The aim of this study is to determine the cost-effectiveness of extracellular matrix (ECM) relative to standard of care (SC) on wound closure for the treatment of mixed arterial/venous (A/V) or venous leg ulcers (VLUs).

Design setting and participants: A two-stage Markov model was used to predict the expected costs and outcomes of wound closure for ECM and SC. Outcome data used in the analysis were taken from an 8-week randomized clinical trial that directly compared ECM and SC. Patients were followed up for an additional 6 months to assess wound closure. Forty-eight patients completed the study; 25 for ECM and 23 for SC. SC was defined as a standard moist wound dressing. Transition probabilities for the Markov states were estimated from the clinical trial.

Main outcomes and measures: The economic outcome of interest was direct cost per closed-wound week. Resource utilization was based on the treatment regimen used in the clinical trial. Costs were derived from standard cost references. The payer's perspective was taken.

Results: ECM-treated wounds closed, on average, after 5.4 weeks of treatment, compared with 8.3 weeks for SC wounds (P=0.02). Furthermore, complete wound closure was significantly higher in patients treated with ECM (P<0.05), with 20 wounds closed in the ECM group (80%) and 15 wounds closed in the SC group (65%). After 8 months, patients treated with ECM had substantially higher closed-wound weeks compared with SC (26.0 weeks versus 22.0 weeks, respectively). Expected direct costs per patient were $2,527 for ECM and $2,540 for SC (a cost savings of $13).

Conclusion and relevance: ECM yielded better clinical outcomes at a slightly lower cost in patients with mixed A/V and VLUs. ECM is an effective treatment for wound healing and should be considered for use in the management of mixed A/V and VLUs.

No MeSH data available.


Related in: MedlinePlus