Cost-effectiveness of Commonly Used Skin Substitutes in the Management of Diabetic Foot Ulcers

Purpose/Aim: Diabetic foot ulcers (DFU) have been estimated to affect 1–4% of patients with diabetes annually and a quarter of patients with diabetes over their lifetimes. Skin substitutes are frequently used to treat the complex DFUs. Cost-effectiveness evidence is lacking particularly among the most prescribed skin substitutes.  

Methods: We developed model using clinical and cost data from a study by Samsell et al 2019. Samsell et al considered the cost effectiveness of skin substitutes during the 12 week treatment period. Our study extended the analysis to one year in order to capture the complication cost of non-healing DFUs. We compared 4 commonly prescribed skin substitutes which are Grafix, ApliGraf, Dermagraft and EpiFix. The analysis was conducted from the payer’s perspective and cost are expressed in US$ 2019.

Results: The healing rates at 12 weeks for Grafix, ApliGraf, Dermagraft and EpiFix were 62%, 48%, 38% and 30% respectively. The estimated mean annual cost per patient is $28,449 for Grafix, $25,370 for ApliGraf, $24,552 for Dermagraft and $33,288 for EpiFix respectively. After removing the dominated option, Grafix is the most cost-effective skin substitute over one year period when compared with ApliGraf. The estimated incremental cost-effectiveness ratio (ICER) is 22,276 per healed DFU. ApliGraf is the second most cost-effective with an ICER of $8,178 per healed DFU compared to Dermagraft. EpiFix results in lower healing and more costs overall and is therefore dominated by all other skin substitutes. These results were not sensitive to changes in price of skin substitutes and other variables.

Conclusions: This study suggest that Grafix appears to be the most cost-effective when all costs are included up to one year followed by ApliGraf, Dermagraft and lastly EpiFix which is dominated. Head to head data of the skin substitutes is needed to update this analysis and should collect data on complications especially amputations which are costly.