A Cost-Effectiveness Analysis Comparing Enzymatic Debridement to Hydrogel Autolytic Debridement of Pressure Ulcers in a Long Term Care Setting

Objective:  To assess the comparative cost-effectiveness of collagenase enzymatic debridement relative to hydrogel autolytic debridement used for the treatment of necrotic pressure ulcers in a long-term care setting. Given the acquisition cost difference between collagenase ointment and hyrdrogel dressings, there is a need to assess the relative value of the two alternatives.

Methods: A 3-stage Markov model¹ was used to determine the expected costs and outcomes of necrotic pressure ulcer care by comparing collagenase ointment to a hydrogel dressing. The three Markov states used in the analysis were an inflamed necrotic ulcer, a proliferative ulcer and a mature epithelialized ulcer. Outcome and resource utilization data were taken from a prospective, randomized, clinical trial that directly compared enzymatic debridement with collagenase ointment to autolysis with a hydrogel dressing for necrotic pressure ulcer therapy in a long-term care facility². A one year time horizon was used to determine the expected costs and outcomes of pressure ulcer therapy.  Resource costs were derived from standard cost references and expressed in 2011 U.S. dollars^3,4. The payer perspective was taken in the economic analysis. No cost discounting was performed due to the short time horizon of the analysis. One-way sensitivity analyses were performed to establish the robustness of the economic results.

Results:The expected number of ulcer free days was estimated 313 and 214 per year for the collagenase and hydrogel therapies, respectively, while the expected annual costs were $1,875 and $5,398, respectively.

Conclusions: The enzymatic debridement of necrotic pressure ulcers with collagenase ointment is both more effective and cost saving in the long term care setting due to its faster progression rate compared to autolytic debridement with a hydrogel dressing.