Cost effectiveness of becaplermin in the treatment of diabetic foot ulcersin four European countries

Objective: The primary objective of this study was to estimate the cost eff ectiveness of treating diabetic foot ulcers with becaplermin (Regranex((R)) ) plus good wound care (GWC) compared with GWC alone in a variety of Europe an healthcare settings. A secondary objective was to analyse the effect of different treatment practices on the economics of caring for diabetic foot ulcers. Design and setting: Markov-based simulation study from the perspective of a national health system. Methods: A 12-month Markov computer simulation model was used to assess the cost effectiveness in 4 European countries of treating diabetic foot ulcer s with becaplermin plus GWC versus GWC alone. Transition probabilities were taken from a prospective study of 183 patients and becaplermin efficacy wa s based on 20-week healing rates in a recent meta-analysis of clinical tria ls involving 449 patients. Country-specific treatment cost data were collec ted in collaboration with local economic consultations and combined with th e disease model to estimate the incremental cost per ulcer-free month gaine d. The model was then run using hypothetical low- and high-intensity resour ce usage profiles to investigate the economics of caring for diabetic foot ulcers. Results: Over the course of 1 year, individuals who received becaplermin pl us GWC were, on average, predicted to spend an additional 0.81 months (24% longer) free of ulcers and to experience a 9% lower risk of undergoing a lo wer extremity amputation than individuals who received GWC alone. Consequen tly, becaplermin plus GWC was estimated to be net cost saving in Sweden, Sw itzerland and the UK. In France, the addition of becaplermin was estimated to add $US19 (1999 values) for each additional ulcer-free month gained. The re were substantial intercountry differences in treatment practices and the costs of treating diabetic foot ulcers. Conclusions: Becaplermin may be a cost-effective treatment for neuropathic diabetic foot ulcers in a wide range of European settings. In Sweden, Switz erland and the UK, becaplermin may even be cost saving. Substantial interco untry differences in resource patterns appear, at least partly, to be the l ogical outcome of differences in unit costs.