Introduction
An acellular single-layer dermal substitute composed of native bovine collagen and elastin can be used in single- and two-step reconstruction surgeries. Due to a lack of cost-effectiveness analysis the objective of this study is to assess the cost-effectiveness of dermal templates in acute and chronic wounds from the perspective of the healthcare systems, considering cost factors such as material cost, hospitalization time and complications.
Methods
The analyses were performed comparing collagen-elastin dermal templates with split-thickness skin graft (STSG) alone and other dermal templates. Diabetic foot ulcer (DFU) and burns were the indications selected to represent chronic and acute wounds. Separate mathematical models were developed for each indication: a Markov model for DFU and a decision tree model for burns. Transition probabilities were obtained through literature search and from clinical studies.
Results
Native collagen-elastin dermal template was cost-effective in all comparisons, leading to savings of GBP 39,879 when compared to other dermal templates in acute wounds with marginal quality-adjusted life-year (QALY) gains). In chronic wounds native collagen-elastin dermal regeneration template led to savings and QALY gains against all comparators with incremental QALYs and cost savings up to GBP 72,726 compared to STSG, other dermal templates and outpatient templates.
Discussion
Highlighting the importance of a holistic economic approach considering cost factors as material costs, hospitalization time and complications native collagen-elastin dermal template has proven to be high effective and less costly. As the clinical data is obtained from heterogeneous populations and varying wound characteristics, the obtained is an excellent indicator.