Wound-Evidence-Based Interventions

Abstract

OBJECTIVES: 1. Define the components of platelet-rich plasma (PRP) gel. 2. Describe the production of PRP gel. 3. Identify cost-effective therapies for treating diabetic foot ulcers. PROBLEM: Nonhealing diabetic foot ulcers and amputations are major costs to the healthcare system. RATIONALE: Episodic cost analyses can be misleading since they don't consider ulcer recurrence, infection, amputation, death, or quality of life outcomes. A long-term analysis determines the impact on the healthcare system. METHODOLOGY: A decision-analysis model was developed by an independent company to evaluate the economic impact of treatment modalities for nonhealing diabetic foot ulcers. The model relied on published data, simulating the clinical and cost outcomes and quality-adjusted life years (QALY) over a five-year period associated with using an autologous platelet-rich plasma (PRP) gel versus other treatment modalities used in treating diabetic ulcers. The model varied rates of healing, recurrence, infection, amputation, and death as documented in prospective randomized controlled trials and data reported in the literature, and associated costs for a hypothetical group of 200,000 patients. RESULTS: The average five-year direct wound care cost per modality and (QALY) was: PRP gel, $15,159 (2.87); saline gel, $33,214 (2.70); standard of care, $40,073 (2.65); ultrasound, $32,659 (2.73); tissue engineered graft A, $40,569 (2.65); graft B, $24,374 (2.79); graft C, $37,340 (2.71); negative pressure wound therapy (NPWT), $20,964 (2.81) and single growth factor, $47,252 (2.69). PRP gel was more clinically effective and less costly than other treatment modalities and had the highest QALYs. CONCLUSION: Using PRP gel to treat nonhealing diabetic foot ulcers could result in important cost savings to the healthcare system and better quality of life for patients (Dougherty).