Carter Marissa J, Gilligan Adrienne M, Waycaster Curtis R, Schaum Kathleen, Fife Caroline E
a Strategic Solutions, Inc. , Cody , WY , USA.
b Truven Health Analytics , Rosenberg , TX , USA.
J Med Econ. 2017 Mar;20(3):253-265. doi: 10.1080/13696998.2016.1252381. Epub 2016 Nov 9.
The purpose of this study was to determine the cost effectiveness (from a payer's perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.
A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.
Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of -$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.
In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.
本研究旨在从支付方的角度，确定在美国伤口登记处登记的患者中，与单纯选择性清创术（非CCO组）相比，在选择性清创术中添加梭菌胶原酶软膏（CCO）治疗IV期压疮的成本效益。
建立一个三状态马尔可夫模型，以确定CCO组和非CCO组在2年时间范围内的成本和结果。结果数据来自一项回顾性临床研究，包括2年内愈合（上皮化）的压疮比例和伤口愈合时间。马尔可夫状态的转移概率根据临床研究进行估计。在马尔可夫模型中，临床结果以无溃疡周数表示，即伤口处于上皮化状态的时间。每个4周周期的成本基于临床研究中的门诊就诊频率、清创频率和CCO应用率。最终模型输出为2年时的累积成本（以美元计）、临床结果（无溃疡周数）和增量成本效益比（ICER）。
与非CCO组相比，CCO组成本更低（11,151美元对17,596美元），效益更高（33.9个无溃疡周对16.8个无溃疡周），导致ICER在经济上占优，为每例溃疡节省375美元。因此，如果选择CCO治疗，每多获得一个无溃疡周，同时可节省375美元成本。在2年期间，每位患者可多获得17.2个无溃疡周，同时节省成本6,445美元。
在这个基于美国伤口登记处真实世界数据的马尔可夫模型中，在压疮治疗中，在选择性清创术中添加CCO在经济上优于单纯选择性清创术，能以更低成本为患者带来更大益处。
