Carter MJ, Gilligan AM, Waycaster CR, Schaum K, Fife CE, et al.
Journal of medical economics. Date of publication 2017 Mar 1;volume 20(3):253-265.
1. J Med Econ. 2017 Mar;20(3):253-265. doi: 10.1080/13696998.2016.1252381. Epub 2016
Nov 9.
Cost effectiveness of adding clostridial collagenase ointment to selective
debridement in individuals with stage IV pressure ulcers.
Carter MJ(1), Gilligan AM(2)(3), Waycaster CR(3)(4), Schaum K(4), Fife CE(5).
Author information:
(1)a Strategic Solutions, Inc. , Cody , WY , USA.
(2)b Truven Health Analytics , Rosenberg , TX , USA.
(3)c University of North Texas Health Sciences Center , Department of
Pharmacotherapy , Fort Worth , TX , USA.
(4)d Smith & Nephew, Inc. , Fort Worth , TX , USA.
(5)e Intellicure, Inc. , The Woodlands , TX , USA.
OBJECTIVE: The purpose of this study was to determine the cost effectiveness
(from a payer's perspective) of adding clostridial collagenase ointment (CCO) to
selective debridement compared with selective debridement alone (non-CCO) in the
treatment of stage IV pressure ulcers among patients identified from the US Wound
Registry.
METHODS: A 3-state Markov model was developed to determine costs and outcomes
between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were
derived from a retrospective clinical study and included the proportion of
pressure ulcers that were closed (epithelialized) over 2 years and the time to
wound closure. Transition probabilities for the Markov states were estimated from
the clinical study. In the Markov model, the clinical outcome is presented as
ulcer-free weeks, which represents the time the wound is in the epithelialized
state. Costs for each 4-week cycle were based on frequencies of clinic visits,
debridement, and CCO application rates from the clinical study. The final model
outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free
weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.
RESULTS: Compared with the non-CCO group, the CCO group incurred lower costs
($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks),
resulting in an economically dominant ICER of -$375 per ulcer. Thus, for each
additional ulcer-free week that can be gained, there is a concurrent cost savings
of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2
ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each
patient.
CONCLUSIONS: In this Markov model based on real-world data from the US Wound
Registry, the addition of CCO to selective debridement in the treatment of
pressure ulcers was economically dominant over selective debridement alone,
resulting in greater benefit to the patient at lower cost.
DOI: 10.1080/13696998.2016.1252381
PMID: 27774840 [Indexed for MEDLINE]
