评估釉原蛋白在不愈合下肢静脉溃疡治疗中的相对成本效益

Guest J F, Nagy E, Sladkevicius E, Vowden P, Price P

Catalyst Health Economics Consultants, Northwood, UK.

J Wound Care. 2009 May;18(5):216, 218-24. doi: 10.12968/jowc.2009.18.5.42176.

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.

METHOD

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.

CONCLUSION

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.

DECLARATION OF INTEREST

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.

目的

从英国国家医疗服务体系的角度，评估使用釉原蛋白加压迫绷带与单独使用压迫绷带治疗病程超过6个月的难愈合下肢静脉溃疡（VLU）的成本效益。

方法

构建一个为期12个月的马尔可夫模型，描述对病程超过6个月的慢性难愈合VLU的管理。该模型考虑临床医生决定用釉原蛋白加压迫绷带或单独用压迫绷带治疗顽固性VLU，并用于估计按2006 - 2007年价格计算的釉原蛋白加压迫绷带的相对成本效益。

结果

根据该模型，预计使用釉原蛋白加压迫绷带治疗的所有伤口中有60%在治疗开始后的12个月内愈合，而单独使用压迫绷带治疗的伤口愈合率为41%（p<0.01）。此外，预计所有接受釉原蛋白治疗的伤口中有23%会有所改善，而单独使用压迫绷带组的伤口改善率为18%。两组在有效性上的这种差异预计会使接受釉原蛋白治疗的患者与单独接受压迫绷带治疗的患者相比，在治疗开始12个月后健康收益提高7%（分别为0.800与0.746质量调整生命年；p<0.01）。预计使用釉原蛋白会使英国国家医疗服务体系在12个月内成本降低10%，从4261英镑（95%置信区间：3409英镑；5114英镑）降至3816英镑（95%置信区间：3227英镑；4405英镑），部分原因是护士访视需求的减少。因此，发现釉原蛋白加压迫绷带是一种占优治疗方法。此外，预计使用釉原蛋白会释放英国国家医疗服务体系的资源以便在系统内用于其他用途。