The cost effectiveness of Apligraf treatment of Diabetic foot ulcers

Background: Diabetic foot ulcers (DFUs) present a treatment challenge andAbstract result in a large economic burden, requiring careful evaluation of the clinical efficacy and cost effectiveness of new treatment modalities. DFU clinical trials of the bio-engineered skin substitute Apligraf (Novartis Pharma AG, Basel, Swit-zerland) have demonstrated improved clinical efficacy compared with good wound care (GWC) alone. Objective: To determine the economic impact and cost effectiveness of Apligraf plus GWC compared with GWC alone in the treatment of DFUs. Study perspective: Societal. Methods: A Markov-based simulation model was created to compare the costs and effects of Apligraf plus GWC to those of GWC alone over a 12-month period. The primary health states were ‘uninfected ulcer’, ‘infected ulcer’, ‘gan-grene’, and ‘healed ulcer’. Transition probabilities were based on clinical trial results, while cost estimates were based on estimates of resource utilisation in the Netherlands. The cost-effectiveness outcome measures were the incremental cos