Cost effectiveness of using carboxymethylcellulose dressing compared with gauze in the management of exuding venous leg ulcers in Germany and the USA

ABSTRACT

Objective: To assess the cost effectiveness of using carboxymethylcellulose dressing (CMCD; Aquacel Hydrofiber) compared to gauze in the management of exuding venous leg ulcers in Germany and the USA.

Design and setting: This was a modelling study performed from the perspective of payers (i.e. the sickness funds in Germany and the community sector in the USA).

Methods: Clinical outcomes attributable to managing exuding venous leg ulcers were obtained from the published literature in the English language. These data were combined with resource utilisation estimates derived from a panel of clinicians enabling us to construct two decision models depicting the management of venous leg ulcers with CMCD or gauze over 18?weeks in Germany and the USA. The models were used to estimate the cost effectiveness of CMCD compared to gauze in the management of exuding venous leg ulcers in both countries.

Main outcome measures and results: Starting treatment with CMCD instead of gauze in both Germany and the USA is expected to heal 30% of ulcers within 18?weeks compared to 13% with gauze (?p = 0.003). The healthcare cost of starting treatment with CMCD or gauze in Germany is expected to be €2020 and €2654 respectively at 18?weeks. Additionally, the healthcare cost of starting treatment with CMCD or gauze in the USA is expected to be $3797 and $5288 respectively at 18?weeks. Hence, using CMCD instead of gauze is expected to increase the probability of healing within 18?weeks by 130% and reduce healthcare costs by at least 24%. The healthcare cost of managing CMCD-treated patients was less than that of gauze-treated patients in both countries due to decreased nursing and physician costs associated with a lower frequency of CMCD dressing changes compared to gauze dressing changes. If it were assumed that treatment with gauze in both countries heals 30% of ulcers within 18?weeks (i.e. is identical to CMCD), then the expected healthcare cost of using gauze would be reduced by only 3% (from €2654 to €2562 in Germany and from $5288 to $5148 in the USA).

Conclusion: Within the limitations of our model, starting management of an exuding venous leg ulcer with CMCD instead of gauze is the cost effective strategy in both Germany and the USA. Moreover, the purchase price of a leg ulcer dressing should not be used as an indication of the cost effectiveness of a given method of care.