商业保险患者中应用活细胞组织产品治疗糖尿病足溃疡和静脉性溃疡的经济学影响：一项回顾性匹配队列研究。
The Economic Impact of Living Cell Tissue Products in Treating Diabetic Foot Ulcers and Venous Leg Ulcers in Patients with Commercial Insurance: A Retrospective Matched-Cohort Study.
机构信息
Adrian Barbul, MD, FACS, is Professor of Surgery, Vanderbilt University School of Medicine and Director, Wound Care Services, Nashville Veterans Administration Hospital, Tennessee, USA. Helen Gelly, MD, FACCWS, UHM/ABPM, FUHM, FACHM, is Chief Executive Officer, HyperbaRxs, Marietta, Georgia. Kayla Obradovic, MS, is Student Research Fellow, Department of Orthopedics, Podiatric Surgery Section, Massachusetts General Hospital, Waltham. Adam Landsman, DPM, PhD, is Assistant Professor of Orthopedic Surgery, FARIL (Foot & Ankle Research Innovation Laboratory), Harvard Medical School, Boston.
出版信息
Adv Skin Wound Care. 2023 May 1;36(5):243-248. doi: 10.1097/01.ASW.0000922704.17906.26.
OBJECTIVE
Previous studies demonstrated that costs paid on behalf of Medicare recipients for diabetic foot ulcers and venous leg ulcers treated with cellular and/or tissue-based products (CTPs) varied in part based on the CTP chosen. This study extends previous work to determine how costs vary when paid by commercial insurance carriers.
METHODS
A retrospective matched-cohort intent-to-treat design was used to analyze commercial insurance claims data between January 2010 and June 2018. Study participants were matched using Charlson Comorbidity Index, age, sex, type of wound, and geographic location within the US. Patients treated with a bilayered living cell construct (BLCC), dermal skin substitute (DSS), or cryopreserved human skin (CHSA) were included.
RESULTS
Wound-related costs and number of CTP applications were significantly lower for CHSA relative to BLCC and DSS at all time intervals (60, 90, and 180 days and 1 year after first application of the CTP). Further, CHSA was associated with significantly fewer amputations at 1 year relative to DSS (14.9% vs 19.7%, P = .03).
CONCLUSIONS
There was a statistically significant reduction in cost of treating diabetic foot ulcers (BLCC, DSS, CHSA) and venous leg ulcers (BLCC, CHSA) with CHSA as compared with the other CTPs. These findings are attributed to fewer applications, lower wound care costs, and comparable or reduced incidence of amputation. These commercial insurance data are consistent with prior studies that examined Medicare expenditures.
目的
先前的研究表明，医疗保险受益人支付的用于治疗糖尿病足溃疡和静脉性腿部溃疡的细胞和/或组织基产品（CTP）的费用部分取决于所选择的 CTP。本研究扩展了先前的工作，以确定当由商业保险公司支付时，成本如何变化。
方法
使用回顾性匹配队列意向治疗设计，分析了 2010 年 1 月至 2018 年 6 月之间的商业保险索赔数据。研究参与者使用 Charlson 合并症指数、年龄、性别、伤口类型和美国地理位置进行匹配。纳入接受双层活细胞构建体（BLCC）、真皮替代物（DSS）或冷冻保存人皮（CHSA）治疗的患者。
结果
在所有时间间隔（CTP 首次应用后 60、90 和 180 天以及 1 年），CHSA 相对于 BLCC 和 DSS 的伤口相关成本和 CTP 应用次数明显更低。此外，与 DSS 相比，CHSA 在 1 年内与截肢相关的发生率显著降低（14.9%比 19.7%，P =.03）。
结论
与其他 CTP 相比，CHSA 治疗糖尿病足溃疡（BLCC、DSS、CHSA）和静脉性腿部溃疡（BLCC、CHSA）的成本有统计学意义的降低。这些发现归因于应用次数减少、伤口护理费用降低以及截肢的发生率相似或降低。这些商业保险数据与之前研究医疗保险支出的研究一致。
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