Economic analysis and budget impact of clostridial collagenase ointment compared with medicinal honey for treatment of pressure ulcers in the US

Figures & data

Figure 1 Three-state Markov diagram of wound healing.

Figure 2 Schematic representation of the Markov model.

Notes: All patients were treated with CCO or MH and entered the model in the “inflammation/senescence” health state. Based on healing rates from the US Wound Registry, patients transitioned to the “granulation” health state until the “epithelialization” health state or the 1-year follow-up ended. Each health state is associated with a cost and quality of life adjustment.
Abbreviations: CCO, clostridial collagenase ointment; MH, medicinal honey; NPWT, negative pressure wound therapy.

Table 1 Health state transition probabilities

Therapy	100% Granulation, weekly	Epithelialization, weekly	Clinic visits, weekly	NPWT, weekly	Debridement, weeklya
CCO	0.0104	0.0064	0.8805	0.0198	0.3317
MH	0.0083	0.0046	0.9227	0.026	0.4422

Notes:

a The baseline case assumes that all debridements were surgical, while sensitivity analysis split the ratio of surgical debridement and selective debridement by the observed ratio performed in additional analysis.

Abbreviations: CCO, clostridial collagenase ointment; MH, medicinal honey; NPWT, negative pressure wound therapy.

Table 2 Procedure and visit costs, 2016 US dollars

Services and procedures performed at encounter (CPT code)			Allowable Charges (CPT/HCPCS code)*
Visit (99213/G0463)	NPWT (97605)*	Debridement	Physician	Facility
	×	Surgical (11042)	$63.37 (11042)	$225.55 (11042); $58.92 (50% of 97605)
		Surgical (11042)	$63.37 (11042)	$225.55 (11042)
	×	Selective (97597)	$23.63 (97597)	$225.55 (97597)
		Selective (97597)	$23.63 (97597)	$225.55 (97597)
	×	Nonselective (97602)	$51.56 (99213)	$117.83 (97602)
		Nonselective (97602)	$51.56 (99213)	$117.83 (97602)
×	×	None	$51.56 (99213)	$117.83 (97605)
×		None	$51.56 (99213)	$102.12 (G0463)

Notes: Even though 2 procedures may be performed during the same HOPD encounter, the payer does not pay for the second procedure or the payer may pay 100% for one procedure and 50% for the other procedure.

* CMS pays 80% and patients pay 20%.

Abbreviations: CMS, Centers for Medicare and Medicaid Services; NPWT, negative pressure wound therapy; CPT, current procedural terminology; HCPCS, health-care common procedure coding system; HOPD, hospital outpatient department.

Table 3 Base case analysis results

Outcome	CCO	MH	Difference between CCO and MH
One-year costs (2016 US dollars)	$6,161	$7,149	−$988
QALWs	22.73	21.89	0.84
Average weeks in granulation stage	11.51	10.64	0.87
Average weeks in epithelization stage	6.04	4.38	1.65
Number of clinic visits	40.07	43.38	−3.31
Number of debridements	12.31	17.61	−5.30
Proportion of patients who reached granulation/proliferation health state	41.4%	34.6%	+6.8%
Proportion of patients who reached epithelization health state	27.6%	20.7%	+6.9%

Abbreviations: CCO, clostridial collagenase ointment; MH, medicinal honey; QALWs, quality-adjusted life weeks.

Figure 3 Results of the one-way sensitivity analysis.

Notes: CCO is cost-effective when ICE < WTP of $962/QALW. CCO is dominant when ICE < $0. Bars represent the range of outcomes from one-way sensitivity analysis.
Abbreviations: E&M, Evaluation and management; CCO, clostridial collagenase ointment; NPWT, negative-pressure wound therapy; ICE, incremental cost-effectiveness; WTP, willingness-to-pay threshold; MH, medicinal honey; QALWs, quality-adjusted life weeks.

Figure 4 Cost-effectiveness acceptability curve.

Abbreviations: CCO, clostridial collagenase ointment; MH, medicinal honey.

Figure 5 Cost-effectiveness scatterplot.

Notes: Random 1,000-sample of the 10,000-iteration MCS with a 95% confidence interval. The center point is the base case scenario average. Dashed line represents WTP of $962; CCO is cost-effective to the right of the line.
Abbreviations: WTP, willingness-to-pay; CCO, clostridial collagenase ointment; MCS, Monte Carlo simulation.