• 1.

    Centers for Disease Control and Prevention: National Diabetes Fact Sheet, 2007. 1-1-2008. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 6-1-2009.

    • Search Google Scholar
    • Export Citation
  • 2.

    Shaw JE, Sicree RA, Zimmet PZ: Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 87: 4, 2010.

  • 3.

    Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA 293: 217, 2005.

  • 4.

    Boulton A, Bowling F: Diabetic Foot Ulcers,” in Controversies in Treating Diabetes, edited by AI Vinik, D LeRoith, p 229, Humana Press, New York, NY, 2008.

    • Search Google Scholar
    • Export Citation
  • 5.

    Snyder RJ, Hanft JR: Diabetic foot ulcers — effects on quality of life, costs, and mortality and the role of standard wound care and advanced-care therapies in healing: a review. Ostomy Wound Manage 55: 28, 2009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 22: 382, 1999.

  • 7.

    Holzer SE, Camerota A, Martens L, et al: Costs and duration of care for lower extremity ulcers in patients with diabetes. Clin Ther 20: 169, 1998.

  • 8.

    Driver VR, De Leon JM: Health economic implications for wound care and limb preservation. J Manag Care Med 11: 13, 2008.

  • 9.

    Ragnarson Tennvall G, Apelqvist J: Health-economic consequences of diabetic foot lesions. Clin Infect Dis 39: S132, 2004.

  • 10.

    Pham HT: Wound care in diabetic foot ulceration. Wounds 12: 82B, 2000.

  • 11.

    Sibbald RG, Torrance G, Hux M, et al: Cost-effectiveness of becaplermin for nonhealing neuropathic diabetic foot ulcers. Ostomy Wound Manage 49: 76, 2003.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Cavanagh PR, Lipsky BA, Bradbury AW, et al: Treatment for diabetic foot ulcers. Lancet 366: 1725, 2005.

  • 13.

    Steed DL, Attinger C, Colaizzi T, et al: Guidelines for the treatment of diabetic ulcers. Wound Repair Regen 14: 680, 2006.

  • 14.

    Baharestani MM, Houliston-Otto DB, Barnes S: Early versus late initiation of negative pressure wound therapy: examining the impact on home care length of stay. Ostomy Wound Manage 54: 48, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    De Leon JM, Nagel M, Fudge M, et al: Early use of negative pressure wound therapy in long-term acute care patients is associated with reduced length of stay. Abstract presented at the Third Congress of the World Union of Wound Healing Societies, June 4–8, 2008, Toronto, Ontario. PF225, 2008.

    • Search Google Scholar
    • Export Citation
  • 16.

    Kaplan M, Daly D, Stemkowski S: Early intervention of negative pressure wound therapy utilizing vacuum assisted closure in trauma patients: impact on hospital length of stay and cost. Adv Skin Wound Care 22: 128, 2009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Congressional Budget Office: Research on the comparative effectiveness of medical treatments. 148. 12-1-2007. Washington, DC, Congress of the United States, Congressional Budget Office.

    • Search Google Scholar
    • Export Citation
  • 18.

    Blume PA, Walters J, Payne W, et al: Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 31: 631, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    [No author listed]. Guideline for management of wounds in patients with lower-extremity arterial disease. 6-1-2002. Glenview, IL, Wound Ostomy and Continence Nurses Society. WOCN clinical practice guideline series; no. 1.

    • Search Google Scholar
    • Export Citation
  • 20.

    Russo CA, Steiner C, Spector W: Hospitalizations related to pressure ulcers among adults 18 years and older, 2006. HCUP Statistical Brief #64, 19. 12-1-2008, Agency for Healthcare Research and Quality, Rockville, MD, 12-7-2010.

    • Search Google Scholar
    • Export Citation
  • 21.

    West Virginia Bureau for Medical Services: 2007 National Physician Fee Schedule Relative Value File. 152. 1-1-2007. West Virginia, West Virginia Department of Health and Human Services (DHHR). 10-18-2011.

    • Search Google Scholar
    • Export Citation
  • 22.

    Centers for Medicare and Medicaid Services (CMS) H: Medicare Program: Prospective payment system and consolidated billing for skilled nursing facilities — Update — Notice. Fed Regist 71: 43158, 2006.

    • Search Google Scholar
    • Export Citation
  • 23.

    Armstrong DG, Lavery LA, Diabetic Foot Study Consortium: Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366: 1704, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Apelqvist J, Armstrong DG, Lavery LA, et al: Resource utilization and economic costs of care based on a randomized trial of vacuum-assisted closure therapy in the treatment of diabetic foot wounds. Am J Surg 195: 782, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Flack S, Apelqvist J, Keith M, et al: An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care 17: 71, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Rogers LC, Lavery LA, Armstrong DG: The right to bear legs–an amendment to healthcare: how preventing amputations can save billions for the US Health-care System. JAPMA 98: 166, 2008.

    • Search Google Scholar
    • Export Citation
  • 27.

    De Leon JM, Barnes S, Nagel M, et al: Cost-effectiveness of negative pressure wound therapy for postsurgical patients in long-term acute care. Adv Skin Wound Care 22: 122, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Lavery LA, Barnes SA, Keith MS, et al: Prediction of healing for post-operative diabetic foot wounds based on early wound area progression. Diabetes Care 31: 26, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Kieser DC, Hammond C: Leading wound care technology: The ARANZ medical silhouette. Adv Skin Wound Care 24: 68, 2011.

Evaluation of Wound Care and Health-Care Use Costs in Patients with Diabetic Foot Ulcers Treated with Negative Pressure Wound Therapy versus Advanced Moist Wound Therapy

Vickie R. Driver Department of Surgery, Veterans Affairs New England Health Care Division, Providence, RI.

Search for other papers by Vickie R. Driver in
Current site
Google Scholar
PubMed
Close
 DPM, MS
and
Peter A. Blume Department of Anesthesiology, Yale School of Medicine, New Haven, CT.

Search for other papers by Peter A. Blume in
Current site
Google Scholar
PubMed
Close
 DPM
Restricted access

Background

We conducted a post-hoc retrospective analysis of patients enrolled in a randomized controlled trial to evaluate overall costs of negative pressure wound therapy (NPWT; V.A.C. Therapy; KCI USA, Inc, San Antonio, Texas) versus advanced moist wound therapy (AMWT) in treating grade 2 and 3 diabetic foot wounds during a 12-week therapy course.

Methods

Data from two study arms (NPWT [n = 169] or AMWT [n = 166]) originating from Protocol VAC2001-08 were collected from patient records and used as the basis of the calculations performed in our cost analysis.

Results

A total of 324 patient records (NPWT = 162; AMWT = 162) were analyzed. There was a median wound area reduction of 85.0% from baseline in patients treated with NPWT compared to a 61.8% reduction in those treated with AMWT. The total cost for all patients, regardless of closure, was $1,941,472.07 in the NPWT group compared to $2,196,315.86 in the AMWT group. In patients who achieved complete wound closure, the mean cost per patient in the NPWT group was $10,172 compared to $9,505 in the AMWT group; the median cost per 1 cm2 of closure was $1,227 with NPWT and $1,695 with AMWT. In patients who did not achieve complete wound closure, the mean total wound care cost per patient in the NPWT group was $13,262, compared to $15,069 in the AMWT group. The median cost to close 1 cm2 in wounds that didn't heal using NPWT was $1,633, compared to $2,927 with AMWT.

Conclusions

Our results show greater cost effectiveness with NPWT versus AMWT in recalcitrant wounds that didn't close during a 12-week period, due to lower expenditures on procedures and use of health-care resources.

Corresponding author: Vickie R. Driver, DPM, MS, FACFAS, Department of Surgery, VA New England Health Care Division, Department of Surgery, 830 Chalkstone Ave, Providence, RI 02908. (E-mail: drvdriver@aol.com)