THE COST-EFFECTIVENESS OF BECAPLERMIN WHEN USED AS AN ADJUNCT THERAPY WITH GOOD DIABETIC FOOT ULCER CARE

Purpose: The objective of this research was to determine the cost-effectiveness of becaplermin when used as an adjunctive therapy to diabetic foot ulcer (DFU) good wound care (GWC).

Method: A Markov model was developed to compare the costs and clinical consequences of DFU GWC alone to good wound care plus becaplermin (GWCB). The Markov model incorporated the costs and clinical outcomes associated with the following DFU health-states: a healed ulcer, an uninfected ulcer, an infected ulcer, a gangrenous ulcer, a lower extremity amputation, a healed ulcer and death. The monthly direct costs assigned with GWC were $2,187 for an uninfected ulcer, $2,514 for an infected ulcer, $2,758 for a gangrenous ulcer and $1,246 for an amputation. The direct cost for a tube of becaplermin was estimated at $696 and the one-time cost for an amputation was estimated at $116,987. The analysis spanned a 12-month time horizon. DFU healing rates, health-state transitions and associated costs used to populate the Markov model were taken from a review of the medical literature and standard cost reference sources. The analysis assumed 2 tubes of becaplermin were required to achieve the modeled outcomes in the base case scenario. Ulcer free months were the clinical effectiveness endpoint assessed in the Markov analysis. One-way deterministic sensitivity analyses were performed to estimate the influence of parameter uncertainty on the economic and clinical outcomes. Costs are expressed as 2011 US dollars and presented from a payer perspective. Due to the short time horizon no cost or outcomes discounting was performed.

Result: The expected outcomes of DFU therapy were 5.1 and 3.4 ulcer free months per year while the estimated base-case direct costs were $16,624 and $19,527 for the GWCB and GWC treatments, respectively. Becaplermin therapy achieved economic dominance at 5 months of therapy in the base-case analysis.  When becaplermin utilization was increased to 4 tubes it remained the dominate therapy with an expected cost of $17,380 compared to GWC alone.

Conclusion: The addition of becaplermin to good diabetic foot ulcer wound care can improve outcomes, which consequently shortens the duration of therapy, thereby reducing the total cost of care to the payer.