Diabetic foot ulcer and V.A.C. resource utilization and economic cost based on a randomized trial
Jan Apelqvist; David G. Armstrong; Lawrence A. Lavery; Andrew JM. Boulton; Dr. William M. Scholl College of
Podiatric Medicine
Symposium for Advanced Wound Care (SAWC), Tampa, Florida, April 28 - May 1 2007
Objective: To evaluate resource utilization and direct economic costs of care for patients treated with negative pressure wound therapy (NPWT) vacuum assisted closure system (V.A.C.) compared to standard moist wound therapy (MWT), in the treatment of partial diabetic foot amputation wounds.
Methods: 162 diabetic patients with post amputation ulcers (up to the trans-metatarsal level) entered a sixteen-week, randomized clinical trial. Patients randomized to VAC (n = 77) received therapy with dressing changes every 48 hours. Control patients (n = 85) received standard MWT. Resource utilization and costs for in-patient hospital care, surgical procedures, re-amputations, post-baseline debridements, antibiotics, outpatient treatment visits, dressing changes and dressing materials were calculated and analysed in this post-hoc retrospective study.
Results: There was no difference between groups for in-patient hospital stay (number of admissions or length of stay). More surgical procedures (including debridement) were performed in the MWT group (120 versus 43 NPWT, P <0.001). The average number of dressing changes performed per patient was 118.0 (range 12–226) for MWT versus 41 (6-140) for NPWT (P = 0.0001). The MWT group had 11 (range 0-106) outpatient treatment visits during the study versus 4 (range 0-47) in the NPWT group (P < 0.05). The average direct cost per patient treated for 8 weeks or longer (independent of clinical outcome) was $27,270 and $36,096 in the NPWT and MWT groups, respectively, yielding an incremental cost difference in favor of NPWT of $8,826. Proportionally, the highest costs were related to in-patient hospital stay, antibiotics and wound dressing treatment. The average total cost to achieve healing was $25,954 for patients treated.