Value-based Healthcare: Using Human Fibroblast-derived Dermal Substitute in the Treatment of Diabetic Foot Ulcers

INTRODUCTION: Treatment of diabetic foot ulcers (DFUs) does not always result in complete healing, places a heavy burden on the patients’ quality of life (QoL), and a significant economic burden on the healthcare system and payers. The analysis of Medicare claims showed an average 18-month follow up cost of $ 81,858 per patient.

OBJECTIVES: (1) To explore DFUs and their burden on the patients’ QoL; (2) To evaluate the limitations of standard of care (SOC) for DFU treatment; (3) To discuss the role of Human Fibroblast-Derived Dermal Substitute (HFDS) in modulating and accelerating the DFU healing process, improving patients’ QoL, and reducing the total medical costs.

METHODS: A narrative review. The search was conducted in October 2019 using PubMed, EMBASE, Cochrane Library, and Google Scholar to retrieve published studies and publicly available data related to QoL of patients with DFUs, limitations of SOC for DFUs, and economic evaluations of using HFDS for treatment of DFUs.

RESULTS: DFUs impact on the patient’s QoL is due to pain, risk of infection, mobility issues, potential risk of amputation leading to death, and other physical, psychological, and emotional anguish. SOC for DFUs include debridement, offloading, infection management, and dressings. Long treatment periods to achieve complete healing and the high risk of ulcer recurrence lead to increased healthcare resource utilization (e.g., frequent outpatient visits and hospitalization) and increased healthcare costs. DFU patients treated with HFDS are 1.91 times (95 % CI=1.12-3.27) more likely to be healed than those treated with SOC alone. Also, a previous study shows HFDS reduces the incidence of amputations by 72%. Improving DFU patients’ QoL, cost-savings, and cost-effectiveness can be achieved by adding HFDS to SOC.

CONCLUSIONS: To reduce overall healthcare costs, healthcare plans should continue HFDS coverage and encourage clinicians to expand use of HFDS for the treatment of DFUs.