Abstract
Current National Institute of Health and Care Excellence (NICE) guidance does not indicate a preferred dressing for patients with Diabetic Foot Ulcer (DFU). UrgoStart has recently been shown as superior to a neutral dressing in the double blind randomised controlled Explorer trial. This study examined the cost-effectiveness of UrgoStart compared with a neutral dressing for DFU patients. A Markov-model was designed with seven health states: open, closed, and complicated (pre and post amputation), and deceased. Complicated wounds can cause an amputation event, moving a patient to the post-amputation block. The model took the perspective of the National Health Service (NHS) in the United Kingdom, with a cohort of 1000 patients and base-case time horizon of 1 year. The Explorer trial informed transition probabilities and health-state utility scores; there were no statistically significant differences between the characteristics of the treatment arms at baseline. Both deterministic and probabilistic sensitivity analyses were performed. UrgoStart was the dominant treatment strategy in terms of cost-effectiveness, with a cost saving of £666.51 and a 0.022 gain in quality-adjusted-life years, per patient. Using UrgoStart leads to more wounds healed at 52 weeks than a neutral dressing, 653 and 473 respectively at a cost of £4879.84 per healed wound for UrgoStart compared with £8136.19 for a neutral dressing. The use of UrgoStart also avoided 19 amputations over a year. Sensitivity analysis showed UrgoStart as cost saving, even when a comparator was set at £0. Across 1000 runs of the model, UrgoStart was dominant every time. This analysis showed UrgoStart to be a cost-effective treatment option, with benefits to the patient and the NHS. Primary cost drivers such as community nurse visits and hospital admissions; can be reduced significantly with faster healing. UrgoStart should be considered as a treatment for all patients with a DFU.
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