INTRODUCTION: Diabetic foot ulcers (DFUs) with exposed bone or tendon can be difficult to heal. These recalcitrant wounds can create an economic burden because they often require multiple treatment applications. New research is needed to identify cost-effective solutions. Both dermacell acellular dermal matrix (D-ADM) and viable cryopreserved human placental membrane (vCHPM) have shown success in treating bone-exposed ulcers.
OBJECTIVE: This health economics analysis compared the cost of each skin substitute using Centers for Medicare & Medicaid cost schedules.
METHODS: Diabetic foot ulcer healing rates and the number of applications needed to achieve healing were obtained retrospectively from 2 similar studies. The cost of healing 1 DFU in a hospital outpatient department (HOPD) was calculated using [(# of Applications)*(Bundled HOPD Payment + Physician Payment)]. The cost of healing 1 DFU in a physician’s office was calculated using [(# of Applications)*(Product Cost per Application + Physician Payment)]. Treatment costs for HOPD were extracted from Quarter 3 2018 CMS Addendum B OPPS Payment using CPT code 15275. Skin substitute cost was calculated using October 2018 Medicare Average Selling Price for vCHPM and invoice cost for D-ADM. The smallest-sized graft for the mean area, 5 cm x 5 cm, was used for calculating cost.
RESULTS: The ulcer areas were comparable, with 13.7 cm2 and 14.6 cm2 for D-ADM (n = 22) and vCHPM (n = 27), respectively. At 16 weeks, D-ADM had a healing rate of 59.1% with a mean of 1 application needed to achieve healing. The vCHPM had a healing rate of 59.3% with a mean of 9 applications needed for healing. The average cost of healing a single DFU in a HOPD was $1667 for D-ADM compared with $15 007 for vCHPM. The mean cost of healing a single DFU in a physician’s office was $1811 for D-ADM compared with $31 129 for vCHPM.
CONCLUSIONS: Despite the equivalent healing rates, vCHPM cost an average of 9 to 17 times more to heal complex DFUs when compared with D-ADM.
