Guest Julian F, Rana Karan, Singh Heenal, Vowden Peter
Catalyst Health Economics Consultants, Rickmansworth, Hertfordshire, UK, and Faculty of Life Sciences and Medicine, King's College, London, UK.
Catalyst Health Economics Consultants, Rickmansworth, Hertfordshire, UK.
J Wound Care. 2018 Feb 2;27(2):68-78. doi: 10.12968/jowc.2018.27.2.68.
To estimate whether collagen-containing dressings could potentially afford the UK's National Health Service (NHS) a cost-effective intervention for the management of non-healing venous leg ulcers (VLUs).
This was a modelling study performed from the perspective of the UK's NHS. A combination of published clinical outcomes, resource utilisation estimates and utilities for VLUs enabled the construction of a decision model, depicting the management of a chronic VLU with standard care or with a collagen-containing dressing plus compression therapy followed by standard care, over a period of 6 months. The model estimated the incremental cost-effectiveness of the two interventions in terms of the incremental cost per quality-adjusted life year (QALY) gained at 2015/16 prices.
The treatment of VLUs of >6 months' duration with a collagen-containing dressing plus compression therapy followed by standard care, instead of standard care, is expected to increase the probability of healing from 0.11 to 0.49 by 6 months and increase health-related quality of life at 6 months from 0.331 to 0.373 QALYs per patient. Additionally, treatment with a collagen-containing dressing plus compression therapy followed by standard care has the potential to reduce management costs by 40% over 6 months when compared with standard care (from £6328 to £3789 per patient).
Within the study's limitations, including a collagen-containing dressing into a standard care protocol compared with standard care potentially affords the NHS a cost-effective (dominant) treatment since it improves outcomes for less cost.
评估含胶原蛋白敷料对英国国家医疗服务体系(NHS)而言,是否可能成为一种具有成本效益的干预措施,用于治疗不愈合的下肢静脉溃疡(VLU)。
这是一项从英国NHS角度开展的建模研究。结合已发表的临床结果、资源利用估计以及VLU的效用值,构建了一个决策模型,该模型描述了在6个月期间,采用标准护理或含胶原蛋白敷料加压迫疗法后再进行标准护理来管理慢性VLU的情况。该模型根据2015/16年价格计算的每获得一个质量调整生命年(QALY)的增量成本,估算了这两种干预措施的增量成本效益。
对于病程超过6个月的VLU,采用含胶原蛋白敷料加压迫疗法后再进行标准护理,而非单纯标准护理,预计6个月时愈合概率将从0.11提高到0.49,且6个月时每位患者与健康相关的生活质量将从0.331 QALY提高到0.373 QALY。此外,与标准护理相比,采用含胶原蛋白敷料加压迫疗法后再进行标准护理有可能在6个月内将管理成本降低40%(从每位患者6328英镑降至37所89英镑)。
在该研究的局限性范围内,与标准护理相比,在标准护理方案中加入含胶原蛋白敷料对NHS而言可能是一种具有成本效益(占优)的治疗方法,因为它能以更低成本改善治疗效果。