Modelling the relative cost-effectiveness of amelogenin in non-healing venous leg ulcers.

Authors: JF Guest, E Nagy, E Sladkevicius, P Vowden & P Price.
Source: Journal of Wound Care 2009; 18(5): 2160-2224.

ABSTRACT

Objective: To assess the cost-effectiveness of using amelogenin plus compression bandaging versus compression bandaging alone in treating non-healing venous leg ulcers (VLUs) of over six months’ duration, from the perspective of the National Health Service (NHS) in England.

Method: A 12-month Markov model was constructed that depicted the management of a chronic, non-healing VLU of over six months’ duration. The model considers the decision by a clinician to treat a recalcitrant VLU with amelogenin plus compression bandaging or compression bandaging alone, and was used to estimate the relative cost-effectiveness of amelogenin plus compression bandaging at 2006–2007 prices.

Results: According to the model, 60% of all wounds treated with amelogenin plus compression bandaging are expected to heal within 12 months of the start of treatment compared with 41% of wounds treated with compression bandaging alone (p<0.01). Additionally, 23% of all amelogenin-treated wounds are expected to improve compared with 18% of wounds in the compression bandaging alone group. This difference in effectiveness between the two groups is expected to lead to a 7% improvement in health gain among amelogenin-treated patients when compared with those treated with compression bandaging alone (0.800 versus 0.746 QALYs; p<0.01) at 12 months after the start of treatment. Use of amelogenin is expected to lead a 10% reduction in NHS cost over 12 months from £4,261 (95% CI: £3,409; £5,114) to £3,816 (95%CI: £3,227; £4,405), due in part to a reduction in the requirement for nurse visits. Hence, amelogenin plus compression bandaging was found to be a dominant treatment. Moreover, use of amelogenin is expected to free-up NHS resources for alternative use within the system.

Conclusion: Within the model’s limitations, amelogenin plus compression bandaging is expected to afford the NHS a cost-effective dressing compared with compression bandaging alone in the management of chronic non-healing VLUs of more than six months’ duration.