A COST-EFFECTIVENESS ANALYSIS COMPARING TWO ALTERNATIVE DEBRIDEMENT THERAPIES FOR NECROTIC PRESSURE ULCERS IN A LONG-TERM CARE SETTING

Purpose: To assess the comparative cost-effectiveness of enzymatic debridement with collagenase ointment versus autolytic debridement with a hydrogel dressing when used to treat necrotic pressure ulcers in a long-term care setting.

Method: A 3-state Markov model was developed to represent the relative stages of pressure ulcer progression and populated with outcomes data taken from a prospective clinical trial. The three Markov states used in the analysis were an inflamed necrotic pressure ulcer, a proliferating healing pressure ulcer and a completely epithelialized pressure ulcer. A one-year time horizon was modeled to determine the expected direct costs and outcomes of the two alternative debridement therapies. Outcome and resource utilization data were taken from a prospective, randomized, clinical trial conducted at a single long-term care facility that directly compared the two alternative debridement therapies in the treatment of necrotic pressure ulcers. At day 42 in the clinical trial debridement rates were assessed at 85% and 29% for the enzymatic and autolytic therapies, respectively. At day 84 in the clinical trial wound closure rates were assessed at 69% and 21% for the enzymatic and autolytic therapies, respectively. The following resources were included in the economic analysis: collagenase ointment, hydrogel dressing, nursing time, occlusive outer dressings, wound irrigation solution and wound care kits. Resource costs were derived from standard cost references and expressed in 2011 U.S. dollars. The health care system perspective was taken in the economic analysis. No cost discounting was performed due to the short time horizon. Sensitivity analyses were performed to assess the impact of parameter uncertainty on the modeled outcomes.

Result: The expected clinical outcomes were estimated at 318 and 219 closed wound days for the collagenase and hydrogel therapies, respectively, and the expected direct costs were estimated at $1,875 and $5,411, respectively.  The sensitivity analysis revealed that the frequency of dressing changes exerted the greatest influence on costs. When dressing frequencies were reduced to the minimum as outlined in the product labels, the expected costs of wound care dropped to $1,207 and $1,804 for the enzymatic and autolytic debridement therapies, respectively.

Conclusion: Enzymatic debridement of necrotic pressure ulcers with collagenase ointment is both more effective and cost saving compared to autolytic debridement with a hydrogel dressing in the long term care setting.