SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm2022.23.01.05 Intact fish skin grafts result in faster time to healing and lower costs to patients with venous leg ulcers and diabetic foot ulcers compared to the standard of care: An outcome-based pricing model Thomas Zehnder , MD, Medical Department, Hospital of Thun, Switzerland Marlise Blatti , Medical Department, Hospital of Thun, Switzerland Correspondence: thomas.zehnder@spitalstsag.ch · Conflict of interests: None Keywords: Diabetic foot ulcers, economic outcomes, fish skin, venous leg ulcers ABSTRACT Introduction Between 10 and 34% of healthcare expenditures are wasted. Given the expansion of the European advanced wound care market to $3.51 billion by 2025, healthcare systems will face problems unless they adopt models that help curb waste and pre- vent myopic spending. This manuscript introduces an outcome-based pricing model. Methods For one year, a Swiss hospital prospectively exam- ined and treated all venous and diabetic wounds meeting inclusion criteria with either standard of care or fish-skin graft. A model for expected time to wound closure was used to evaluate the conditions and assess how well surrogate endpoints predict wound outcomes. Results Data show that surrogate endpoints are predictive enough to facilitate clinical decision-making regard- ing the use of intact fish skin grafts much earlier than the grafts used in usual models. While the intact fish skin graft products are initially more expensive than standard of care, they allow decision-makers to take hospital length of stay and other factors into account. Further, the difference in cost was quite substantial in favour of fish skin grafts over the long term. This model allows payors to mitigate risks when evaluating novel products, as healthcare systems do not pay for worse outcomes in new products. Even with this added cost, innovators benefit by reaping more data to use when refining products. Conclusions Balancing innovation, care and cost with the system stresses to come will likely require a new means of understanding all three. This model provides a po- tential solution to one thorny juncture of these forces. INTRODUCTION The move towards outcome-based pricing agreements An OECD report on healthcare spending 1 reported that, on average, between 10 and 34% of healthcare expenditures are wasted on unnecessary procedures or drugs, inappropriate patient care, administrative costs or even corruption. These inefficient expenditures, coupled with the drastically rising costs of health- care and treatment, are prompting many healthcare systems to explore different reimbursement models, such as outcome or value-based healthcare. At present, there is no single definition of value-based healthcare, or what ‘value’ means in a health context; here, ‘value’ is defined as patient outcomes relative to the money spent to achieve that outcome, that is, the cost-effectiveness of treatments or procedures. Health technology assessment bodies in European countries tend to make decisions on the reimburse- ment of new health technologies at the national level based on their cost-effectiveness; this value is often JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION 23
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