Wen, J.

Economic Evaluation of Sucrose Octasulfate Dressing for the Treatment of Diabetic Foot Ulcers
Wen, J., Jin, X., & Ohinmaa, A.

The Explorer trial has found that diabetic patients with non-infected neuroischemic diabetic foot ulcers (DFU) treated with sucrose octasulfate (SOS) dressing versus control dressing showed improvement in ulcer healing. In January 2019, the National Institute for Health and Care Excellence (NICE) published a guideline on using SOS dressing to treat DFUs. However, this new intervention is not used in Canada. A cost-utility analysis of SOS dressing versus currently-used dressings would help to inform the decision-makers about the benefits and values of using SOS dressing. Therefore, we developed a state-transition model to estimate the incremental cost-utility ratio (ICUR) from a Canadian public payer's perspective.

We incorporated effectiveness data from the Explorer trial and other DFU-related prospective studies, costs data from Canadian published studies and databases, and utility parameters from the Alberta's Caring for Diabetes (ABCD) database. We addressed uncertainty through one-way and probabilistic sensitivity analyses (PSA).

Compared with currently-used dressings, using SOS dressing has an increase of 0.07 quality-adjusted life-years (QALYs) and a decrease of $5,913.05 per patient over a 5-year time horizon at the deterministic analysis. The ICUR was $ -85,878.36/QALY, with 82.58% chance of being cost-effective, and more precisely, with 62.78% chance of being cost-saving.

Our results are consistent with the results from KiTEC, an external assessment centre for NICE. We only see limited additional effectiveness for SOS dressing. This is partially due to the limitation of our utility data sources. The ABCD cohort is a relatively healthy diabetic patient population. Less than 5% of patients having DFU or being amputated. Therefore the utility distributions have many overlaps. However, the costs saved by using SOS dressing is obvious, as a large amount of money spending in amputation and ulcer management has been saved up. Therefore, SOS dressing is very likely to be cost-saving in Canada.