Bayesian Regression Model for a Cost-Utility and Cost-Effectiveness Analysis Comparing Punch Grafting Versus Usual Care for the Treatment of Chronic Wounds

Abstract

Punch grafting is a traditional technique used to promote epithelialization of hard-to-heal wounds. The main purpose of this observational study was to conduct a cost-utility analysis (CUA) and a cost-effectiveness analysis (CEA) comparing punch grafting (n = 46) with usual care (n = 34) for the treatment of chronic wounds in an outpatient specialized wound clinic from a public healthcare system perspective (Spanish National Health system) with a three-month time horizon. CUA outcome was quality-adjusted life years (QALYs) calculated from EuroQoL-5D, whereas CEA outcome was wound-free period. One-way sensitivity analyses, extreme scenario analysis, and re-analysis by subgroups were conducted to fight against uncertainty. Bayesian regression models were built to explore whether differences between groups in costs, wound-free period, and QALYs could be explained by other variables different to treatment. As main results, punch grafting was associated with a reduction of 37% in costs compared to usual care, whereas mean incremental utility (0.02 ± 0.03 QALYs) and mean incremental effectiveness (7.18 ± 5.30 days free of wound) were favorable to punch grafting. All sensitivity analyses proved the robustness of our models. To conclude, punch grafting is the dominant alternative over usual care because it is cheaper and its utility and effectiveness are greater.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

“…Selva-Sevilla et al 24 have recently analyzed the cost effectiveness of punch grafting compared with the standard of wound care. The authors conclude that punch graft must be considered over usual care for the early treatment of chronic wounds because it is cheaper, and its utility and effectiveness are greater.…”

Long‐term cost‐effectiveness analysis of sacral neuromodulation in the treatment of severe faecal incontinence

“…After definitive implantation, there was a significant decrease in the mean number of days per week with an incontinent episode, from 4.98 (SD: 2.1) to 1.25 (SD: 1.7), and in mean Wexner's score from 16.88 (SD: 2.74) to 6.95 (SD: 3.54). Specific FIQL and generic EQ-5D questionnaires showed a significant improvement in quality of life.…”

“…A Bayesian regression model using simultaneous equations was applied in this study [16][17][18]. The model was subdivided according to of the variables associated with effectiveness.…”

Prise en charge des ulcères chroniques : la greffe en pastilles

“…13 De plus, une analyse coûtefficacité montre que les greffes en pastilles sont associées à une réduction des coûts par rapport aux soins habituels avec une augmentation de la qualité de vie des patients. 14 À la lumière de ces données, l'EWMA (European Wound Management Association) a récemment proposé le débridement léger suivi d'une greffe en pastilles, comme traitement chirurgical de première ligne pour les patients présentant un ulcère d'angiodermite nécrotique de petite taille. 15 De manière intéressante, les greffes épidermiques, en raison de la très faible profondeur de prélèvement, ne provoquent pas de phénomène de pathergie et constituent donc une très bonne alternative en présence de certaines pathologies comme le pyoderma gangrenosum.…”