Cost-effectiveness of TLC-NOSF dressings versus neutral dressings for the treatment of diabetic foot ulcers in France

• Published in: PloS one Vol. 16; no. 1; p. e0245652
• Main Authors: Maunoury, Franck, Oury, Anaïs, Fortin, Sophie, Thomassin, Laetitia, Bohbot, Serge
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.01.2021; Public Library of Science (PLoS)
• Subjects: Amputation; Analysis; Biology and Life Sciences; Care and treatment; Comparative analysis; Cost analysis; Diabetes; Diabetes mellitus; Diabetic foot; Diabetic neuropathy; Disease; Dressings; Ethics; Feet; Foot diseases; Health insurance; Health risks; Health services; Infections; Leg ulcers; Medical care, Cost of; Medicine and Health Sciences; Neuropathy; Patients; People and places; Physical Sciences; Social Sciences; Subgroups; Surgical dressings; Transdermal medication; Ulcers; Wound healing; France; Italy; United Kingdom > UK; Germany; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0245652

This study assesses the cost-effectiveness of Technology Lipido-Colloid with Nano Oligo Saccharide Factor (TLC-NOSF) wound dressings versus neutral dressings in the management of diabetic foot ulcers (DFUs) from a French collective perspective. We used a Markov microsimulation cohort model to simulate the DFU monthly progression over the lifetime horizon. Our study employed a mixed method design with model inputs including data from interventional and observational studies, French databases and expert opinion. The demographic characteristics of the simulated population and clinical efficacy were based on the EXPLORER double-blind randomized controlled trial. Health-related quality of life, costs, and resource use inputs were taken from the literature relevant to the French context. The main outcomes included life-years without DFU (LYsw/DFU), quality-adjusted life-years (QALYs), amputations, and lifetime costs. To assess the robustness of the results, sensitivity and subgroup analyses based on the wound duration at treatment initiation were performed. Treatment with the TLC-NOSF dressing led to total cost savings per patient of EUR 35,489, associated with gains of 0.50 LYw/DFU and 0.16 QALY. TLC-NOSF dressings were established as the dominant strategy in the base case and all sensitivity analyses. Furthermore, the model revealed that, for every 100 patients treated with TLC-NOSF dressings, two amputations could be avoided. According to the subgroup analysis results, the sooner the TLC-NOSF treatment was initiated, the better were the outcomes, with the highest benefits for ulcers with a duration of two months or less (+0.65 LYw/DFU, +0.23 QALY, and cost savings of EUR 55,710). The results from the French perspective are consistent with the ones from the German and British perspectives. TLC-NOSF dressings are cost-saving compared to neutral dressings, leading to an increase in patients' health benefits and a decrease in the associated treatment costs. These results can thus be used to guide healthcare decisionmakers. The potential savings could represent EUR 3,345 per treated patient per year and even reach EUR 4,771 when TLC-NOSF dressings are used as first line treatment. The EXPLORER trial is registered with ClinicalTrials.gov, number NCT01717183.