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

Carmen Selva-Sevilla, Elena Conde-Montero and Manuel Gerónimo-Pardo
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Carmen Selva-Sevilla: Department of Applied Economy, Facultad de Ciencias Económicas y Empresariales de Albacete, Universidad de Castilla La Mancha, Plaza de la Universidad 1, 02071 Albacete, Spain
Elena Conde-Montero: Department of Dermatology, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031 Madrid, Spain
Manuel Gerónimo-Pardo: Department of Anesthesiology, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02006 Albacete, Spain

IJERPH, 2020, vol. 17, issue 11, 1-21

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.

Keywords: health economics; economic evaluation; health outcomes; health care; quality-adjusted life years; EuroQoL-5D; sensitivity analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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