Mearns Elizabeth S, Liang Michael, Limone Brendan L, Gilligan Adrienne M, Miller Jeffrey D, Schaum Kathleen D, Waycaster Curtis R
Truven Health Analytics, an IBM Company, Cambridge, MA, USA.
Smith & Nephew, Inc., Fort Worth, TX, USA.
Clinicoecon Outcomes Res. 2017 Aug 16;9:485-494. doi: 10.2147/CEOR.S133847. eCollection 2017.
Pressure ulcer (PU) treatment poses significant clinical and economic challenges to health-care systems. The aim of this study was to assess the cost-effectiveness and budget impact of enzymatic debridement with clostridial collagenase ointment (CCO) compared with autolytic debridement with medicinal honey (MH) for PU treatment from a US payer/Medicare perspective in the hospital outpatient department setting.
A cost-effectiveness analysis using a Markov model was developed using a 1-week cycle length across a 1-year time horizon. The three health states were inflammation/senescence, granulation/proliferation (ie, patients achieving 100% granulation), and epithelialization. Data sources included the US Wound Registry, Medicare fee schedules, and other published clinical and cost studies about PU treatment.
In the base case analysis over a 1-year time horizon, CCO was the economically dominant strategy (ie, simultaneously conferring greater benefit at less cost). Patients treated with CCO experienced 22.7 quality-adjusted life weeks (QALWs) at a cost of $6,161 over 1 year, whereas MH patients experienced 21.9 QALWs at a cost of $7,149. Patients treated with CCO achieved 11.5 granulation weeks and 6.0 epithelization weeks compared with 10.6 and 4.4 weeks for MH, respectively. The number of clinic visits was 40.1 for CCO vs 43.4 for MH, and the number of debridements was 12.3 for CCO compared with 17.6 for MH. Probabilistic sensitivity analyses determined CCO dominant in 72% of 10,000 iterations and cost-effective in 91%, assuming a benchmark willingness-to-pay threshold of $50,000/quality-adjusted life year ($962/QALW). The budget impact analysis showed that for every 1% of patients shifted from MH to CCO, a cost savings of $9,883 over 1 year for a cohort of 1,000 patients was observed by the payer.
The results of these economic analyses suggest that CCO is a cost-effective, economically dominant alternative to MH in the treatment of patients with PUs in the hospital outpatient department setting.
压疮（PU）治疗给医疗保健系统带来了重大的临床和经济挑战。本研究的目的是从美国医保支付方/医疗保险的角度，在医院门诊环境中评估用梭菌胶原酶软膏（CCO）进行酶促清创与用医用蜂蜜（MH）进行自溶性清创治疗PU的成本效益和预算影响。
使用马尔可夫模型进行成本效益分析，周期长度为1周，时间跨度为1年。三种健康状态分别为炎症/衰老、肉芽形成/增殖（即患者肉芽形成达到100%）和上皮形成。数据来源包括美国伤口登记处、医疗保险费用表以及其他已发表的关于PU治疗的临床和成本研究。
在为期1年的基础病例分析中，CCO是经济上占主导地位的策略（即同时以更低的成本带来更大的益处）。接受CCO治疗的患者在1年中经历了22.7个质量调整生命周（QALW），成本为6161美元，而接受MH治疗的患者经历了21.9个QALW，成本为7149美元。接受CCO治疗的患者达到肉芽形成11.5周和上皮形成6.0周，而接受MH治疗的患者分别为10.6周和4.4周。CCO的门诊就诊次数为40.1次，而MH为43.4次，CCO的清创次数为12.3次，而MH为17.6次。概率敏感性分析确定，在10000次迭代中，72%的情况下CCO占主导地位，在假设支付意愿基准阈值为50000美元/质量调整生命年（962美元/QALW）的情况下，91%的情况下具有成本效益。预算影响分析表明，对于每1%从MH转向CCO的患者，支付方观察到一组1000名患者在1年中可节省成本9883美元。
这些经济分析结果表明，在医院门诊环境中治疗PU患者时，CCO是一种具有成本效益、在经济上占主导地位的替代MH的方法。
