title: Wound closure in patients with DFU: a cost-effectiveness analysis of two cellular/tissue-derived products.
abstract: OBJECTIVE
  Determine the cost-effectiveness of extracellular matrix (ECM) relative to human fibroblast-derived dermal substitute (HFDS) on diabetic foot ulcer (DFU) wound closure.
  
  
  METHODS
  Outcomes data were obtained from a 12-week, randomised, clinical trial of adults aged 18 years or older diagnosed with type 1 or type 2 diabetes with a DFU. Patients were treated with either ECM or HFDS treatment. A two-state Markov model (healed and unhealed) with a 1-week cycle length was developed using wound-closure rates from the trial to estimate the number of closed-wound weeks and the expected DFU cost per patient. Results were recorded over 12 weeks to estimate the number of closed-wound weeks per treatment and the average cost to achieve epithelialisation (primary outcome). The perspective of the analysis was that of the payer, specifically the Centers for Medicare and Medicaid Services. No cost discounting was performed because of the short duration of the study.
  
  
  RESULTS
  The study consisted of 26 patients, with 13 in each group. In the ECM group, 10 wounds closed (77%), with an average closure time of 36 days; 11 wounds closed in the HFDS group (85%), with an average closure time of 41 days. There was no significant difference between these results (p=0.73). Over 12 weeks, the expected cost per DFU was $2522 (£1634) for ECM and $3889 (£2524) for HFDS. Patients treated with HFDS incurred total treatment costs that were approximately 54% higher than those treated with ECM. Sensitivity analyses revealed that the total cost of care for two applications of HFDS was more costly than eight applications of ECM by approximately $500 (£325).
  
  
  CONCLUSIONS
  In patients with DFU, ECM yielded similar clinical outcomes to HFDS but at a lower cost. Health-care providers should consider ECM as a cost-saving alternative to HFDS.
  
  
  BACKGROUND
  A.M. Gilligan, and C.R. Waycaster, are employees of Smith & Nephew Inc.. This study was funded by Smith & Nephew Inc.. A.L. Landsman, reports no conflicts of interest.
authors.affiliation: Manager, Health Economics and Outcomes Research, Adjunct Assistant Professor, Smith & Nephew Inc., Fort Worth, TX.
authors.forename: A M
authors.initials: AM
authors.lastname: Gilligan
authors.forename: C R
authors.initials: CR
authors.lastname: Waycaster
authors.forename: A L
authors.initials: AL
authors.lastname: Landsman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages / Q000191:economics*; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D017719:Diabetic Foot / Q000191:economics* / Q000628:therapy*; D005109:Extracellular Matrix; D005260:Female; D005347:Fibroblasts; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D017768:Skin, Artificial / Q000191:economics*; D016896:Treatment Outcome; D014481:United States; D058106:Wound Closure Techniques / Q000191:economics*; D014945:Wound Healing
keywords: cost-effectiveness; diabetic foot ulcer; extracellular matrix; human fibroblast-derived dermal substitute