Russo Salvatore, Landi Stefano, Courric Stephane
Department of Management, University of Venice, Venezia, Italy.
Department of Business Administration and Management, University of Verona, Verona, Italy.
Clinicoecon Outcomes Res. 2022 Jan 3;14:1-10. doi: 10.2147/CEOR.S327191. eCollection 2022.
Diabetic chronic foot ulcers (DFU) lead to pain, reduced quality of life and represent a severe economic burden for patients and health systems. The clinical results of PRP effectiveness in the treatment of DFU are promising; on the other hand, the costs associated with treating DFUs with PRP are higher than those using standard therapy. Therefore, this study aims to determine the cost-effectiveness of platelet-rich plasma (PRP) therapy compared to standard therapy from the French healthcare system perspective.
A cost-effectiveness analysis (CEA) was performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk and with ulcers graded 3A according to University of Texas classification. The effectiveness outcomes are reported in terms of quality adjusted life year (QALY). The costs are reported in euro (€) currency evaluated in 2019. A micro-costing approach alongside a clinical study was used to assess resource use. Deterministic sensibility analyses are reported to evaluate the robustness of the results. The analyses were carried out in the French setting.
The incremental cost-effectiveness ratio (ICER) of PRP treatment is -€613/ QALY, which, being lower than zero, indicates the dominance of the PRP therapy. Deterministic and probabilistic sensitivity analysis underlines the main parameter affecting CE results. Lowest number of standard of care weekly medications (from 5 to 3) leads to a €622/QALY while increasing PRP weekly medication (from 1 to 4) has an ICER of €732/QALY.
PRP is a cost-effective or even a cost-saving alternative in the French setting. PRP has higher cost for the complete medication, but, in the absence of wound complications, has the potential to involve lower consumption of resources in the form of routine medication over a 1-year time horizon.
糖尿病慢性足溃疡（DFU）会导致疼痛，降低生活质量，给患者和医疗系统带来沉重的经济负担。富血小板血浆（PRP）治疗DFU的临床效果很有前景；另一方面，用PRP治疗DFU的成本高于标准疗法。因此，本研究旨在从法国医疗系统的角度确定与标准疗法相比，富血小板血浆（PRP）疗法的成本效益。
采用决策马尔可夫模型对一组慢性DFU（病程>3周）、骨科风险高且根据德克萨斯大学分类法溃疡分级为3A的患者进行成本效益分析（CEA）。有效性结果以质量调整生命年（QALY）报告。成本以2019年评估的欧元（€）货币报告。采用微观成本核算方法并结合临床研究来评估资源使用情况。报告确定性敏感性分析以评估结果的稳健性。分析在法国背景下进行。
PRP治疗的增量成本效益比（ICER）为-€613/QALY，低于零，表明PRP疗法占优势。确定性和概率敏感性分析强调了影响成本效益结果的主要参数。护理标准每周用药数量最少（从5种降至3种）导致ICER为€622/QALY，而增加PRP每周用药（从1次增至4次）的ICER为€732/QALY。
在法国背景下，PRP是一种具有成本效益甚至节省成本的替代方案。PRP的完整用药成本较高，但在无伤口并发症的情况下，在1年时间范围内有可能以常规用药的形式减少资源消耗。
