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Cost-effectiveness of becaplermin gel on wound healing of diabetic foot ulcers.

Abstract
We sought to determine the long-term cost effectiveness (payer's perspective) of becaplermin gel plus good wound care (BGWC) vs. good wound care (GWC) alone in terms of wound healing and risk of amputation in patients with diabetic foot ulcers (DFUs). Outcomes data were derived from a propensity score-matched cohort from the Curative Health Services database between 1998 and 2004, which was followed for 20 weeks. A four-state Markov model was used to predict costs and outcomes of wound healing and risk of amputation for BGWC vs. GWC alone over 1 year in patients with DFU. The primary outcome was closed-wound weeks. Transition probabilities for healing and amputation were derived from the aforementioned propensity score-matched cohorts. Ulcer recurrence was estimated from the medical literature. Utilization for becaplermin was calculated using the dosing algorithm in the product labeling. Of 24,898 eligible patients, 9.6% received BGWC. Based on the model, patients treated with BGWC had substantially more closed-wound weeks compared with GWC (16.1 vs. 12.5 weeks, respectively). More patients receiving BGWC had healed wounds at 1 year compared with those receiving GWC (48.1% vs. 38.3%). Risk of amputation was lower in the BGWC cohort (6.8% vs. 9.8%). Expected annual direct costs for DFU were $21,920 for BGWC and $24,640 for GWC. BGWC was economically dominant over GWC, providing better outcomes at a lower cost in patients with DFU. Compared with GWC alone, BGWC is more effective in healing wounds and lowering amputation risk, thereby decreasing long-term costs for DFU.
AuthorsAdrienne M Gilligan, Curtis R Waycaster, Travis A Motley
JournalWound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society (Wound Repair Regen) 2015 May-Jun Vol. 23 Issue 3 Pg. 353-60 ISSN: 1524-475X [Electronic] United States
PMID25810233 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Copyright© 2015 by the Wound Healing Society.
Chemical References
  • Angiogenesis Inducing Agents
  • Gels
  • Proto-Oncogene Proteins c-sis
  • Becaplermin
Topics
  • Amputation, Surgical (statistics & numerical data)
  • Angiogenesis Inducing Agents (administration & dosage, economics)
  • Becaplermin
  • Cost-Benefit Analysis
  • Diabetic Foot (drug therapy, economics, epidemiology)
  • Female
  • Gels
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Propensity Score
  • Proto-Oncogene Proteins c-sis (administration & dosage, economics)
  • Severity of Illness Index
  • Treatment Outcome
  • United States (epidemiology)
  • Wound Healing (drug effects)

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