A Cost Analysis of Two Skin Substitutes for Treatment of Large Diabetic Foot Ulcers with Exposed Bone or Tendon

Objectives: Diabetic foot ulcers (DFUs) with exposed bone or tendon can be difficult to heal. These recalcitrant wounds can create an economic burden because they often require multiple treatment applications. New research is needed to identify cost-effective solutions. Both D-ADM* and vCHPM^ have shown success in treating bone-exposed ulcers. This health economics analysis compared the cost of each skin substitute using CMS cost schedules.

Methods: DFU healing rates and the number of applications needed to achieve healing were retrospectively obtained from two similar studies. The cost of healing one DFU in a hospital outpatient department (HOPD) was calculated using [(# of Applications)*(Bundled HOPD payment + Physician Payment)]. The cost of healing one DFU in a physician’s office was calculated using [(# of Applications)*(Product Cost per Application + Physician Payment)]. Treatment costs for HOPD were extracted from Quarter 3 2018 CMS Addendum B OPPS Payment using CPT code 15275. Skin substitute cost was calculated using October 2018 Medicare Average Selling Price for vCHPM and invoice cost for D-ADM (3).  The smallest-sized graft for the mean area, 5 x 5 cm, was used for calculating cost.

Results: The ulcer areas were comparable, with 13.7 cm2 and 14.6 cm2 for D-ADM (n=22) and vCHPM (n=27), respectively. At 16 weeks, D-ADM had a healing rate of 59.1% with a mean 1.0 application needed to achieve healing. vCHPM had a healing rate of 59.3% with a mean 9.0 applications needed for healing. The average cost of healing a single DFU in a HOPD was $1,667 for D-ADM compared to $15,007 for vCHPM. The mean cost of healing a single DFU in a physician’s office was $1,811 for D-ADM compared to $31,129 for vCHPM. Despite the equivalent healing rates, vCHPM cost 9-17 times more on average to heal complex DFUs compared to D-ADM.