Cost Effectiveness in the Clinic

In this video, David Armstrong, PhD, DPM, discusses how DHACM treatment led to reductions in amputations, hospital readmissions, and cost for patients with diabetic ulcers.

This is the first of 2 videos with Dr. Armstrong as part of an Advances campaign. For additional content, read more here.

Transcript

I'm David Armstrong. I'm professor of surgery at the Tech School of Medicine at the University of Southern California. It's a pleasure to be here today with you.

I was surprised by how consistent these data are now across different types of skin substitutes, and then even for this one specific skin substitute. And it all seems to be marching in one direction. Which frankly surprised me in a pleasant way. We saw reductions in amputations, which I was moderately surprised by. What I was really surprised by was the consistency of reduction in hospital readmissions, emergency department visits. Those sorts of things were not on my initial sort of assumption radar beforehand. But these were significant across the board, which is really, really promising, especially when you're starting to look, as I said, away from just per patient kind of widgetized therapies toward a more broad based kind of public health benefit for some of these therapies.

I believe that now what we're going to start to see is we're starting to build on some of the randomized control trials that have been done in this area and what this additional evidence is going to do is going to likely support the contention that maybe we should start considering using some of these therapies. And I speak for myself as well, by the way, because I'm a notorious, I think, under utilizer of many of the skin substitutes in a clinical setting versus in an operating room setting. But I think maybe we can start considering using some of these things earlier and especially if we can now identify patients that will benefit from this the most. And I think we're starting to see that now emerge from these large scale data sets.

When I hear things like cost effectiveness or whatever, contribution margin, or any of these terms, I frankly feel personally like I have to take a shower whenever I hear it. Because I don't want anything frankly to get in between me and my patient. And I've always felt that way and I've kept myself in some ways, even though I've studied aspects of cost effectiveness over the last 25 years or more, I've still tried to keep myself blissfully ignorant to a lot of these things too, for the reasons that I mentioned. But I think if we are as a collectively, as a practitioner, as a clinician personally, but collectively as a family in this area, in limb preservation and tissue repair and wound healing, we're going to get more wide access of this on the right patients. I think we have to be speaking this language as well. And so that's my sort of evolution here in evaluating cost effectiveness with my co-authors.