Acellular Fish Skin Graft Performance Against Predicted Outcomes in DFU and its Economic Modeling

Introduction: The use of prognostic and cost models gives healthcare providers a relatively quick and easy opportunity to estimate when it will be cost efficient to use advanced treatment such as biologic skin substitutes.

Purpose: In this cost simulation study the Margolis prognostic model for DFUs was used to evaluate the potential cost benefit of using acellular fish skin* for hard to heal wounds.

Methods: Retrospective collection of data from 27 DFUs treated with acellular fish skin* at a single center which was inserted into a prognostic model, and compared with the actual outcome of the treatment. This delta between the two groups was then multiplied against a standardized cost model which includes; the cost of product, the cost of application, and weekly versus daily standard of care dressing and nursing costs.

Results: These 27 patients had had hard to heal wounds with an average age of 16 weeks, Wagner grade 2,03 and wound size of 4.58cm2. The prognostic model predicted that only 42% would close after 20 weeks with standard of care. Using an average of 5,6 applications of fish skin, those wounds took on average 8,7 weeks to close with 89% closing. The fish skin treatment resulted in 2.18x more healed wounds than predicted at 20 weeks. This resulted in a 62.5% total cost reduction for those patients that healed despite the added cost of the skin substitute for an average savings of $3018 per wound treated.

Conclusion: This study shows that over a 20 week treatment period the use of fish skin for hard to heal DFUs can lead to improved outcomes and cost savings for healthcare providers. Further studies could demonstrate if the use of fish skin is cost beneficial for more wound types and less severe wounds.