Cost-effectiveness analysis for the treatment of Diabetic foot ulcer in France: PRP vs standard of care

Background. Diabetic chronic foot ulcers lead to pain, discomfort and represent a severe economic burden for patients and health systems. The increasing prevalence in diabetes, will lead a higher incidence and costs for Diabetic chronic foot ulcers in next years. Conventional treatment have a rate of healing of around 60/70%. Despite treatment, many chronic ulcers fail to heal or persist for months/years and/or recur after healing, requiring additional advanced wound care therapies for adequate healing. There is an increasing literature showing that platelet rich plasma (PRP) has the potential to improve healing rates over standard care. The clinical results of PRP effectiveness in the treatment of DFU are promising, on the other hand the costs associated with treating DFUs with PRP are presumably higher than using standard therapy. Objectives. The aim of this work is to carry out an economic evaluation of the use of the Platelet-Rich Plasma (PRP) therapy in the treatment for Diabetic foot ulcer. Methods. A cost-effectiveness analysis (CEA) were performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk (neuropathy +/- arteriopathy) and with plantar ulcers 3A (UT classification). The effectiveness outcomes are reported in terms of Quality Adjusted Life Year (QALY). The costs are reported in Euro (€) currency evaluated in 2018. A micro-costing approach alongside a clinical study was used to assess the resource use. Deterministic sensibility analyses are reported in order to evaluate the robustness of the results and account for the different sources of uncertainty. The analyses have been carried out in the France setting. Results. PRP treatment for DFU could be considered a cost-effective or even a cost-saving alternative to standard of care in the French setting. The results needs to be interpreted in light of a low level of evidence and calls for more high-quality randomized controlled trials possibly with longer term follow up are required.