Venous ulcers are the most common chronic
wounds of the lower leg.
Skin substitutes recently have been introduced to stimulate nonhealing
wounds. To conduct an incremental cost-effectiveness analysis, a model was developed to compare the four-layer
bandage system, with and without one application of
skin substitute, for the outpatient treatment of venous
leg ulcers. The model estimated the costs and consequences of treatment with and without the
skin substitute application. Two analytic horizons were explored: 3 months and 6 months. Determined by seven physicians, data and assumptions for the 3-month model were based on information from a clinical trial, published studies, and clinical experience. Data for the 6-month model were extrapolated from the shorter model. The model results indicate that over 3 months, the use of the
skin substitute provided a benefit of 22
ulcer days averted per patient at an incremental cost of $304 (societal). The incremental cost-effectiveness ratio was $14 per
ulcer day averted. Over 6 months, the incremental cost-effectiveness ratio was less than $5 per
ulcer-day averted. The
skin substitute plus a four-layer
bandage was more costly and more effective than the four-layer
bandage alone. The
skin substitute is increasingly cost-effective over a longer analytic horizon and in a subgroup of patients with
ulcers of long duration (greater than 1-year duration at baseline). The results come from a model that is based on a series of estimates and assumptions, and accordingly, confirmation of this finding in a prospective study is encouraged.