An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers.
OBJECTIVE
To determine the cost-effectiveness ofVacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US.


METHODS
A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed.


RESULTS
The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings.


CONCLUSIONS
The model results indicate thatVAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost ofVAC therapy and the utility weights applied to health states.
Flack
S
S
York Health Economics Consortium, University of York, UK.
Apelqvist
J
J
Keith
M
M
Trueman
P
P
Williams
D
D
D000671:Amputation, Surgical; D001458:Bandages / Q000191:economics*; D003362:Cost-Benefit Analysis; D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D008390:Markov Chains; D054843:Negative-Pressure Wound Therapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014618:Vacuum