title: Cost-effectiveness of using adjunctive porcine small intestine submucosa tri-layer matrix compared with standard care in managing diabetic foot ulcers in the US.
abstract: To estimate the cost-effectiveness of using tri-layer porcine small intestine submucosa (SIS; Oasis Ultra) as an adjunct to standard care compared with standard care alone in managing diabetic foot ulcers (DFUs) in the US, from the perspective of Medicare.
  
  
  
  A Markov model was constructed to simulate the management of diabetic neuropathic lower extremity ulcers over a period of one year in the US. The model was used to estimate the cost-effectiveness of initially using adjunctive SIS compared with standard care alone to treat a DFU in the US at 2016 prices.
  
  
  
  At 12 months after the start of treatment, the use of adjunctive SIS instead of standard care alone is expected to lead to a 42 % increase in the number of ulcer-free months, 32 % increase in the probability of healing, a 3 % decrease in the probability of developing complicated ulcers and a 1 % decrease in the probability of undergoing an amputation. Health-care resource use is expected to be reduced by 11-14 % among patients who are initially managed with adjunctive SIS compared with those initially managed with standard care alone, with the exception of debridement, which is expected to be reduced by 35 %. Hence, the total health-care cost of starting treatment with adjunctive SIS instead of standard care alone was estimated to reduce payer costs by 1% (i.e. $105 per patient) over 12 months following the start of treatment.
  
  
  
  Within the study's limitations, the use of adjunctive SIS instead of standard care alone improves outcome for less cost and thereby affords a cost-effective use of Medicare-funded resources in the management of neuropathic foot ulcers among adult patients with type 1 or 2 diabetes mellitus in the US.
authors.affiliation: Director of Catalyst, Visiting Professor of Health Economics, Catalyst Health Economics Consultants, Northwood, Middlesex, UK; and Faculty of Life Sciences and Medicine, King's College, London, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Guest
authors.affiliation: Health Economist, Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: D
authors.initials: D
authors.lastname: Weidlich
authors.affiliation: Health Economist, Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: H
authors.initials: H
authors.lastname: Singh
authors.affiliation: Professor of Plastic Surgery; University of Texas, Southwestern Medical Center, Dallas, TX, US.
authors.forename: J
authors.initials: J
authors.lastname: La Fontaine
authors.affiliation: Assistant Professor, Ben Hogan Bone & Joint Clinic, Fort Worth, TX, US.
authors.forename: A
authors.initials: A
authors.lastname: Garrett
authors.affiliation: Associate Professor of Surgery, Director, Multidisciplinary Diabetic Foot & Wound Clinic, Diabetic Foot & Wound Clinic, The Johns Hopkins Hospital, Baltimore, MD, US.
authors.forename: C J
authors.initials: CJ
authors.lastname: Abularrage
authors.affiliation: Director, Health Economics, Smith & Nephew Biotherapeutics, Fort Worth, TX, US.
authors.forename: C R
authors.initials: CR
authors.lastname: Waycaster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D017719:Diabetic Foot / Q000191:economics / Q000451:nursing / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D017768:Skin, Artificial; D013552:Swine; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Oasis Ultra; United States; cost-effectiveness; diabetic foot ulcer; porcine small intestine submucosa tri-layer matrix