Cost-effectiveness analysis of the human recombinant epidermal growth factor in the management of patients with diabetic foot ulcers

Abstract

Introduction: Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient. Although a proportion of patients achieve a spontaneous closure of ulcers, others require medical or surgical treatment. Objective: To determine the cost-effectiveness of the intra- and perilesional application of recombinant human epidermal growth factor (rhEGF), as opposed to conventional therapy for the management of patients diagnosed with Wagner’s 3 or 4 diabetic foot ulcer in Colombia. Methodology: Using a Markov model, the process of care of a diabetic patient with diagnosis of Wagner’s 3 or 4 ulcer receiving conventional treatment, or intra- and perilesional rhEGF, is configured. The evaluation cycles of the treatments are weekly over a 5-year horizon and the outcomes evaluated are quality-adjusted life years (QALYs) and the number of amputations avoided by each treatment scheme, in addition to the total costs for treatments. Results: For the analysed base case, in the outcome of amputations, it was found that the factor presents 39 fewer amputations, in a cohort of 100 patients, compared with conventional treatment. Likewise, QALYs are 0.65 more with the use of rhEGF in an average patient. The estimated cost-utility ratio for the base case would be below the threshold established for Colombia. Conclusions: The intra- and perilesional application of rhEGF is a more effective therapeutic option than conventional therapy in the treatment of patients with Wagner’s 3 or 4 diabetic foot ulcers and is cost-effective, taking as an outcome the QALYs for Colombia from the perspective of the health system.

Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: A systematic review

“…Study setting and cohort. Study settings were diverse and accounted for South America, [41,55] Australia, [42] Canada, [43] China, [59] Europe [47,49,[51][52][53][54]56] and North America [44-46, 48, 50, 57, 58] (Table 2). Patients across all age groups 18 years and over were captured.…”

“…Patients across all age groups 18 years and over were captured. Four cohorts were derived from clinical trials [44,50,57,58] and some studies focused on moderate to severe, [48,[55][56][57] or non-healing [44] DFUs only. DFU infection was a part of the clinical presentation or model pathway in all studies.…”

“…The economic perspective taken by each study determines the cost and benefits included. [17] The societal perspective was taken by Cárdenas et al [41] and Redekop et al [54] The perspective of the healthcare system was taken in six studies [42,43,50,55,57,59] and the payers perspective was taken in five [45,46,49,56,58] (Table 2). Both the societal and payers perspectives were taken by Guo et al [48] Perspective was not reported in five studies, [44,47,[51][52][53] however Ortegon et al [51] discussed some results from the policy and clinical perspective.…”

“…Most economic evaluations assessed adjuncts to standard wound care strategies. [41,47,[54][55][56] Two studies assessed becaplermin gel plus good wound care (GWC) [52,58] and two studies assessed hyperbaric oxygen therapy (HBOT). [43,48] The overall wound care strategy was compared in three studies, each comparing what was locally considered as standard versus optimal wound care.…”

“…One-year [41,45,54,58] and five-year time horizons were most common. [42,44,53,55,56,59] The longest time horizon was 12-years by Chuck et al [43] Short time horizons were taken by Gilligan et al [46] and Guest et al [47] of three and four months respectively. Two time horizons were taken in two papers, Tesar et al [56] used 5-and 10-year time horizons and Lobmann et al [49] used 20-week and 100-week time horizons.…”