MIMEDX Group, Inc., US.
College of Podiatric Medicine, Western University of Health Sciences, US.
J Wound Care. 2022 Feb 1;31(Sup2):S10-S31. doi: 10.12968/jowc.2022.31.Sup2.S10.
To evaluate the cost-effectiveness and budget impact of using standard care (no advanced treatment, NAT) compared with an advanced treatment (AT), dehydrated human amnion/chorion membrane (DHACM), when following parameters for use (FPFU) in treating lower extremity diabetic ulcers (LEDUs).
We analysed a retrospective cohort of Medicare patients (2015-2019) to generate four propensity-matched cohorts of LEDU episodes. Outcomes for DHACM and NAT, such as amputations, and healthcare utilisation were tracked from claims codes, analysed and used to build a hybrid economic model, combining a one-year decision tree and a four-year Markov model. The budget impact was evaluated in the difference in per member per month spending following completion of the decision tree. Likewise, the cost-effectiveness was analysed before and after the Markov model at a willingness to pay (WTP) threshold of $100,000 per quality adjusted life year (QALY). The analysis was conducted from the healthcare sector perspective.
There were 10,900,127 patients with a diagnosis of diabetes, of whom 1,213,614 had an LEDU. Propensity-matched Group 1 was generated from the 19,910 episodes that received AT. Only 9.2% of episodes were FPFU and DHACM was identified as the most widely used AT product among Medicare episodes. Propensity-matched Group 4 was limited by the 590 episodes that used DHACM FPFU. Episodes treated with DHACM FPFU had statistically fewer amputations and healthcare utilisation. In year one, DHACM FPFU provided an additional 0.013 QALYs, while saving $3,670 per patient. At a WTP of $100,000 per QALY, the five-year net monetary benefit was $5003.
The findings of this study showed that DHACM FPFU reduced costs and improved clinical benefits compared with NAT for LEDU Medicare patients. DHACM FPFU provided better clinical outcomes than NAT by reducing major amputations, ED visits, inpatient admissions and readmissions. These clinical gains were achieved at a lower cost, in years 1-5, and were likely to be cost-effective at any WTP threshold. Adoption of best practices identified in this retrospective analysis is expected to generate clinically significant decreases in amputations and hospital utilisation while saving money.
评估在下肢糖尿病性溃疡（LEDU）的使用参数下，与标准治疗（无高级治疗、NAT）相比，使用高级治疗（AT）、脱水人羊膜/绒毛膜（DHACM）的成本效益和预算影响。
我们分析了 Medicare 患者（2015-2019 年）的回顾性队列，以生成 LEDU 发作的四个倾向匹配队列。从索赔代码中跟踪 DHACM 和 NAT 的结果，如截肢和医疗保健利用，并用于构建混合经济模型，结合一年的决策树和四年的马尔可夫模型。在决策树完成后，根据每个成员每月的支出差异评估预算影响。同样，在马尔可夫模型之前和之后，在愿意支付（WTP）阈值为每质量调整生命年（QALY）10 万美元的情况下，分析了成本效益。分析是从医疗保健部门的角度进行的。
有 10900127 名患有糖尿病诊断的患者，其中 1213614 名患有 LEDU。从接受 AT 的 19910 个发作中生成了第一组倾向匹配。只有 9.2%的发作是按规定使用 DHACM，DHACM 被确定为 Medicare 发作中使用最广泛的 AT 产品。第四组倾向匹配受到仅使用 DHACM 按规定使用的 590 个发作的限制。按规定使用 DHACM 的发作的截肢和医疗保健利用率较低。在第一年，DHACM 按规定使用可额外增加 0.013 QALY，同时为每位患者节省 3670 美元。在 WTP 为每 QALY100000 美元的情况下，五年的净货币效益为 5003 美元。
这项研究的结果表明，与 NAT 相比，DHACM 按规定使用可降低 LEDU Medicare 患者的成本并改善临床效益。与 NAT 相比，DHACM 按规定使用通过减少主要截肢、ED 就诊、住院和再入院，提供了更好的临床结果。在 1-5 年内，这些临床收益的成本更低，并且在任何 WTP 阈值下都可能具有成本效益。采用本回顾性分析中确定的最佳实践预计将在减少截肢和医院利用的同时节省资金，从而显著降低临床效益。
