Modelling the relative cost-effectiveness of amelogenin in non-healing venous leg ulcers.
OBJECTIVE
To assess the cost-effectiveness of using amelogenin plus compression bandaging versus compression bandaging alone in treating non-healing venous leg ulcers (VLUs) of over six months duration, from the perspective of the national health service in England.


METHODS
A 12-month Markov model was constructed that depicted the management of a chronic, non-healing VLU of over six months duration. The model considers the decision by a clinician to treat a recalcitrant VLU with amelogenin plus compression bandaging or compression bandaging alone, and was used to estimate the relative cost-effectiveness of amelogenin plus compression bandaging at 20062007 prices.


RESULTS
According to the model, 60% of all wounds treated with amelogenin plus compression bandaging are expected to heal within 12 months of the start of treatment compared with 41% of wounds treated with compression bandaging alone (p<0.01). Additionally, 23% of all amelogenin-treated wounds are expected to improve compared with 18% of wounds in the compression bandaging alone group. This difference in effectiveness between the two groups is expected to lead to a 7% improvement in health gain among amelogenin-treated patients when compared with those treated with compression bandaging alone (0.800 versus 0.746 QALYs; p<0.01) at 12 months after the start of treatment. Use of amelogenin is expected to lead a 10% reduction in NHS cost over 12 months from pound4,261 (95% CI: pound3,409; pound5,114) to pound3,816 (95% CI: pound3,227; pound4,405), due in part to a reduction in the requirement for nurse visits. Hence, amelogenin plus compression bandaging was found to be a dominant treatment. Moreover, use of amelogenin is expected to free-up NHS resources for alternative use within the system.


CONCLUSIONS
Within the models limitations, amelogenin plus compression bandaging is expected to afford the NHS a cost-effective dressing compared with compression bandaging alone in the management of chronic non-healing VLUs of more than six months duration.


BACKGROUND
This study was sponsored by Mölnlycke Heath Care. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
Catalyst Health Economics Consultants, Northwood, UK.
J F
JF
Guest
E
E
Nagy
E
E
Sladkevicius
P
P
Vowden
P
P
Price
D053523:Amelogenin / Q000191:economics / Q000627:therapeutic use; D001458:Bandages / Q000191:economics; D003131:Combined Modality Therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008390:Markov Chains; D018803:Models, Economic; D012008:Recurrence; D017592:Skin Care / Q000191:economics / Q000379:methods; D013222:State Medicine / Q000191:economics; D053828:Stockings, Compression / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D014945:Wound Healing
D053523:Amelogenin