The TLC-NOSF (UrgoStart, Urgo Medical) advanced wound care dressing was recently recommended by the UK National Institute for Health and Care Excellence (NICE) for healing of venous and diabetic foot ulcers. Speaking at the European Wound Management Association annual meeting (EWMA; 5–7 June, Gothenburg, Sweden), Isaac Odeyemi from Manchester Metropolitan University in Manchester, UK presented the results of two cost-effectiveness studies examining the economic impact of UrgoStart dressing use on the healthcare systems of the UK and Germany.
Both studies involved a Markov-model cost-effectiveness design using four states of patient health, with a further distinction made between pre- and post-amputation wounds. Referring to the EXPLORER double-blinded randomised controlled trial, which demonstrated the safety and efficacy of the dressing, Odeyemi noted that the trial informed the model efficacy parameters of their analysis, supplemented by estimates from the literature. In the models for UK, the EXPLORER study’s endpoint of 20 weeks was extrapolated to a base-case time horizon of one year, which was further extended to 100 weeks in the German model.
Costs were analysed from individual countries’ perspectives, and adjusted for 2017 prices. As reported by NICE in their recommendation for UrgoStart dressings, Odeyemi quoted an average annual cost-saving of “up to £5.4 million each year, if only 25% of people having treatment with diabetic foot ulcers in the UK use UrgoStart”. He explained that the study “therefore aims to report the economic evidence underpinning the UK NICE guidance on UrgoStart, as well as explore the perspective from the German Stautatory Health Insurance.”
In the UK, Odeyemi reported the study demonstrated a cost saving of £342 per patient over one year, with a healing time reduced by “up to 60 days”. In the German study, the model demonstrated a lower cost per effectively treated bleed of €6,77.58 for the UrgoStart group, compared to €10,375.56 for the control group over the 100 week period.
Surprisingly, Odeyemi said, “sensitivity analyses also showed that UrgoStart was dominant in terms of all the model input varied. […] You could give any other dressing in the healthcare system for free—and UrgoStart would still be cost-saving.” This is a rare result in a health economics analysis, he stated, emphasising that the dressing was economically dominant in both the UK and the German studies: “two independent studies giving us exactly the same result.”
In conclusion, Odeyemi emphasised the importance of the finding: “This is actually quite significant—it is a lot of money that healthcare systems can actually save. The main cost driver was the efficacy of the TLC-NOSF compared to neutral advanced wound care dressings. Furthermore, earlier use of the dressing resulted in even better efficacy, higher cost savings and better quality of life.”