Cost Analysis and Conclusions of a Fish Skin Graft vs Standard of Care in the Management of Chronic Diabetic Foot Ulcers

Editorial Board Member Dr. Stephen Bergquist and Dr. Eric J. Lullove share final thoughts about costs and reimbursement issues from the original research, “Final Efficacy and Cost Analysis of a Fish Skin Graft vs Standard of Care in the Management of Chronic Diabetic Foot Ulcers: A Prospective, Multicenter, Randomized Controlled Clinical Trial.”

Transcript

Dr. Steve Bergquist:

Hey, good day everybody. I'm Steve Bergquist, medical doctor and wound care physician in the Tennessee area. Happy to be sort of guiding some of this discussion today on a very interesting subject.

Dr. Eric Lullove:

So, hi everybody. I am Dr. Eric Lullove. I am a foot and ankle podiatrist, wound care specialist, based in Coconut Creek, Florida. So for those of you not knowing where that is, I'm about an hour north of Miami.

Dr. Steve Bergquist:

Where I think we're actually going to see the benefit of these numbers is as more and more of our groups become, across the country, reimbursed based on quality of care, quality metrics, how well they took care of and had results, at a lower cost. And then that is the remuneration as opposed to, I get paid every time I see them.

So moving from the model of payment per visit, into the payment of 'this is the budget I've got to work with, I've got to get the best results out of my budget.' And getting those best results we can see is possible when we step upfront with a high quality [product].

Dr. Eric Lullove:

Yeah. And I think the real argument to have with your local hospitals, or your local purchasing groups, or whoever's making the final decision, is that the cost in any treatment--whether you're doing collagen allogeneic therapy, or other collagen therapies, or you're going to go to advanced cellular tissue products--is that you have to look at the metrics on the cost of the patients whose ulcers closed with a given therapy and those that are not closing with a given therapy.

You have to look at both metrics. And the greater the numbers of the ulcers that do not close, there's going to be a higher cost of the given therapy, because you're doing it for a longer period of time. So I think we have to kind of break all this evidence-based cost analysis down to a very simple one-word line that we can all use for our internal marketing, I guess.

And the fact of the matter is that it is ultimately cheaper to close the wound than it is to keep it open. As far as the conclusions go, I think significantly the percent area reduction that we showed at 12 weeks, 86%, was truly a remarkable number to have. The increased cost of using the tissue graft far outweighs not healing the patient, from another take-home point.

And I think as we do this, as we move forward with all these tissues, I really think the comparative studies between fish skin graft and other tissue therapies to show the legitimate difference, or to not show any difference. A lot of us anecdotally will say all the studies that are out there really don't show one product having superiority over the other. Well, if we could have NIH funding to show comparatives, to get comparative study grants, that would be wonderful. I know those are lacking. But I think as all researchers, we'd like to have as much grant funding as possible to do this.

And the biggest limitation is because we don't get grant funding, a lot of these studies are run by industry. There's some industry bias within every clinical trial that we do in this space. And I'll be the first one to admit it, because I'm partially responsible for some of that bias because of the work that we do. And until we are legitimately recognized by the NIH to get grant money, this is where we're at.

Dr. Steve Bergquist:

So I appreciate the honesty of limitations because this is something that should always be considered. And if somebody is online looking at this study, wondering, okay, do I believe this data, do I believe somebody else's? I think one of the things that helps them zero in and say, this must be real data, is when you've got a presentation by an investigator like yourself who not only can show the details, but can say, here's my limitations, I'd like to see these improve. Knowing that you're not just giving one side of the coin, you're trying to show both sides of the picture and say, we've got something here for you to look at.