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To evaluate the cost effectiveness of a treatment method, cost should be measured in terms of cost per unit outcome (Phillips, 1996). An analysis of collagen wound dressings and conventional wound care products illustrate how collagen dressings may decrease total treatment costs based upon assumptions of healing time and expenditures of wound care resources.
Diabetic and other chronic wounds may take years to heal or may not heal at all (American Diabetes Association, 1996; Palmieri, 1992). According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), between 1989 and 1992, an average of 54,000 diabetes-related amputations were performed in the United States (NIDDK, 1995). Diabetic complications account for approximately 50 percent of all non-traumatic amputations in the Unites States (NIDDK, 1995). Costs for diabetic patients treated with amputation were $43,000 for minor amputation and $65,000 for major amputation (Apelqvist, et al., 1995). In cases of diabetic foot ulcers, costs could range from approximately $22,000 to $36,000 depending on the method used (Bentkover & Champion, 1993).
In the United States, the average cost of treating one leg ulcer is about $40,000 per year (Phillips, 1994). In cases of burns covering 30 percent of body surface, estimated costs range between $37,000 and $41,000 (Lofts, 1991). In 1992, hospital emergency room (ER) departments reported 34 million visits that were considered injury-related and require wound treatment. Approximately $9.8 billion was spent on injury-related treatment in ERs (Centers for Disease Control & Prevention, 1995). In another study, 50 percent of the healed venous stasis ulcers recurred within three months of discharge and two-thirds within in one year (Morris, et al., 1994).
Alternative approaches to wound care such as growth factors and artificial skin have projected greater efficacy than traditional dressings with significantly greater costs. Public domain information indicates average treatment costs for alternative approaches range from $10,000 30,000 in the treatment of chronic wounds (Sturza Medical Investment, 1996). Extrapolation of public domain data projects the average costs of these approaches to be approximately $16,500. By these estimates, BioCore's Kollagen™ products would be approximately one-fourth of the projected cost of alternative treatments and one-third of the cost of traditional methods on an average chronic wound.
| Table 1: Chronic Wound Cost Analysis* | |||
|---|---|---|---|
| Kollagen | Traditional Dressing | Other Technologies | |
| Treatment Time | 60 days | 180 days | 90 days |
| Total Product Costs | $960 | $2,100 | $16,500 |
| Secondary Dressing Costs | $400 | 0 | Information not available |
| Support Costs | $4,000 | $12,000 | $6,000 |
| Total Costs | $5,360 | $14,100 | $22,500 |
| Wound Closure Rate | 95% | 43% | 50-60% |
| Table II: Surgical and Traumatic Wound Treatment Cost Analysis | ||
|---|---|---|
| Kollagen | Xeroform® | |
| Dressing Treatment Time to Closure | 8 days | 12 days |
| Kollagen Costs | $26 | 0 |
| Support Costs | $800 | $1200 |
| Xeroform® Costs | $48 | j $72 |
| Total Costs | $874 | $1272 |
As stated earlier, calculating cost effectiveness for wound care is a difficult process because few standards exist. Accounting for indirect costs associated with patient quality of life issues (lost days from work, etc.) can be even more complex to calculate. Medical professionals should consider psychological impacts such as loss of independence, feeling of fear, lack of social contact and loss of self-confidence (ICWM, 1994). Reduced healing time and decreased need for medical care allow patients to enjoy a better quality of life and return to normal activities.