title: Cost-effectiveness of three adjunct cellular/tissue-derived products used in the management of chronic venous leg ulcers.
abstract: OBJECTIVE
  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.
authors.affiliation: Strategic Solutions, Inc., Cody, WY, USA.
authors.forename: Marissa J
authors.initials: MJ
authors.lastname: Carter
authors.affiliation: Smith and Nephew, Fort Worth, TX, USA. Electronic address: Curtis.Waycaster@smith-nephew.com.
authors.forename: Curtis
authors.initials: C
authors.lastname: Waycaster
authors.affiliation: Smith and Nephew, Fort Worth, TX, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schaum
authors.affiliation: Smith and Nephew, Fort Worth, TX, USA.
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Gilligan
mesh_terms: D002908:Chronic Disease; D020099:Coated Materials, Biocompatible / Q000191:economics; D058128:Compression Bandages / Q000191:economics; D003362:Cost-Benefit Analysis; D005109:Extracellular Matrix; D006801:Humans; D007871:Leg Ulcer / Q000191:economics* / Q000628:therapy*; D008390:Markov Chains; D018803:Models, Economic; D017768:Skin, Artificial / Q000191:economics; D014647:Varicose Ulcer / Q000191:economics* / Q000628:therapy*; D014945:Wound Healing
chemical_list: D020099:Coated Materials, Biocompatible
keywords: adjunct therapy; compression therapy; cost-effectiveness; healing trajectory; living skin equivalent; small intestinal submucosa; ulcer recurrence; venous leg ulcers