Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers

Abstract

Objective: The purpose of this study was to determine the cost effectiveness (from a payer’s perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.

Methods: A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.

Results: Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of −$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.

Conclusions: In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.

Keywords:

• Collagenase ointment
• debridement
• pressure ulcer
• cost-effectiveness
• healing rate
• clinical outcome
• economic outcome

Transparency

Declaration of funding

This study was funded by Smith & Nephew, Inc., Fort Worth, TX.

Declaration of financial/other relationships

MJC is a consultant and was paid by Smith & Nephew for this investigation. AMG is a former employee of Smith & Nephew and has no conflicts of interest to disclose. CRW & KS are employees of Smith & Nephew, Fort Worth, TX, and may own shares of Smith & Nephew. CEF is Executive Director of the Chronic Disease Registry (d/b/a the US Wound Registry), a 501c(3) organization that provided some of the data used in this study. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Joann Hettasch, PhD, of Arbor Communications, Inc., a member of the Fishawack Group of Companies, Conshohocken, Pennsylvania, who provided medical writing assistance on behalf of Smith & Nephew.