Original Title: Análisis coste efectividad de la terapia tópica de presión negativa para el tratamiento de las úlceras venosas de pierna

Authors' objectives: To carry out a cost effective analysis comparing negative pressure therapy with moist wound dressings in the treatment of leg venous ulcers in hospitalized patients.

Authors' results and conclusions: The deterministic results for the decision model for scenario 1, in which hospitalization costs are included in the cost calculations, show that the alternative of treating leg venous ulcers in hospitalized patients with NPWT is less costly (18.814 € if the NPWT system is VAC® or 18.644 € if the system is RENASYS® compared to 26.823 € for MWD) and more effective (0,95 life years gained without ulcer vs. 0,89) than the alternative of treatment with MWD. For scenario 2, where hospitalization costs are not included, the results of the decision model show that treatment of leg venous ulcers in hospitalized patients with NPWT is more expensive (815 € if the NPWT system is VAC® or 645 € if the system is RENASYS® vs. 540 € for MWD, and more effective (0,95 life years gained without ulcer vs. 0,89) than the alternative treatment with MWD. The ICER of NPWT vs. MWD is of 4.818 €/ year of life without ulcer for the VAC® system, or 1.850 €/year of life without ulcer for the RENASYS® system, meaning that for each year of life gained the cost to pay is 4.818 € or 1.850 € depending on the system used. The results of the sensitivity analysis for scenario 1, reflected in the tornado diagram point out hospitalization costs and number of changes per week of the products used in NPWT as the mayor influence in ICER. In scenario 2, The variables that influence the most in ICER are: the number of changes per week of the products/ drapes used in NPWT (drainage equipment, polyurethane foam and the exudates container), of the compressive bandages and the products/drapes used in MWD (hydro fibers hydrocolloids, polyurethane non adhesive foam and hydro gels), the cost of the products used for NPWT and the probability if healing with the NPWT treatment. CONCLUSIONS In hospitalized patients with leg venous ulcers, NPWT treatment is dominant vs. MWD treatment for scenario 1 (considering hospitalization costs) or cost effective for scenario 2 (not considering hospitalization costs) according to the confidence verge recommended by the Macroeconomic and Health commission of the World Health Organization (WHO).

Authors' methods: From the perspective of the financer of the National Health System and for a temporal horizon of a year, a determinist analytic model was developed (Markov Model) for decision making in order to estimate the costs and results of NPWT compared with the use of dressings of MWD for the treatment of leg venous ulcers. The implementation of the Markov Model shows the progression (natural history) of leg venous ulcers through three stages: non healed ulcer, healed ulcer and death. The duration of the model cycles are of a month. The mentioned model doesn’t take into account ulcer recurrence. The analyzed population is patients over 70 years of age, hospitalized with venous ulcers of more than six months of duration and with a median surface of the ulcer of 30 cm2 or more. To obtain the necessary data to calculate the main effective measure of the economic analysis, “years of life gained without ulcers”, a search of medical literature in the main databases was performed. Only direct costs related with the procedures studied have been considered, meaning, cost of the products needed to do the NPWT (cost associated with the NPWT device, NPWT drainage equipment with foam and the exudates container), cost of the dressings used in MWD, cost of non-adhesive drapes, bandages used in compression therapy, staff costs (DUE) and hospitalization cost. The prices and consumption of the necessary resources for the cost calculations are mainly obtained from the Home Hospitalization Service, purchase department of the University Cruces Hospital, Of the Human resources Sub-direction and payroll of Osakidetza central Services and from the literature. To determine if in hospitalized patients with leg venous ulcers NPWT therapy is cost effective compared with MWD, the incremental cost effective ratio has been calculated, this shows the medium incremental cost associated with NPWT vs. MWD therapy per year gained without ulcer. An univariant sensitivity analysis has been performed to assess the uncertainness of the model variables and to evaluate the strength of the obtained data. The results have been represented by a tornado diagram, which identifies the parameters with most impact in the variability of the model results.

Project Status: Completed

Year Published: 2015

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051722&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>