Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease

Ezeofor, V‘S; Bray, N; Bryning, L; Hashmi, F; Hoel, H; Parker, DJ; Tudor Edwards, R

Abstract

Background: Critical limb ischaemia is a severe stage of lower limb peripheral artery disease which can lead to tissue loss, gangrene, amputation and death. FlowOx™ therapy is a novel negative-pressure chamber system intended for home use to increase blood flow, reduce pain and improve wound healing for patients with peripheral artery disease and critical limb ischaemia. Methods: A Markov model was constructed to assess the relative cost-effectiveness of FlowOx™ therapy compared to standard care in lower limb peripheral artery disease patients with intermittent claudication or critical limb ischaemia. The model used data from two European trials of FlowOx™ therapy and published evidence on disease progression. From an NHS analysis perspective, various FlowOx™ therapy scenarios were modelled by adjusting the dose of FlowOx™ therapy and the amount of other care received alongside FlowOx™ therapy, in comparison to standard care. Results: In the base case analysis, consisting of FlowOx™ therapy plus nominal care, the cost estimates were £12,704 for a single dose of FlowOx™ therapy per annum as compared with £15,523 for standard care. FlowOx™ therapy patients gained 0.27 additional quality adjusted life years compared to standard care patients. This equated to a dominant incremental cost-effectiveness ratio per QALY gained. At the NICE threshold WTP of £20,000 and £30,000 per QALY gained, FlowOx™ therapy in addition to standard care had a 0.80 and 1.00 probability of being cost-effectiveness respectively. Conclusions: FlowOx™ therapy delivered as a single annual dose may be a cost-effective treatment for peripheral artery disease. FlowOx™ therapy improved health outcomes and reduced treatment costs in this modelled cohort. The effectiveness and cost-effectiveness of FlowOx™ therapy is susceptible to disease severity, adherence, dose and treatment cost. Research assessing the impact of FlowOx™ therapy on NHS resource use is needed in order to provide a definitive economic evaluation.

Citation

Ezeofor, V., Bray, N., Bryning, L., Hashmi, F., Hoel, H., Parker, D., & Tudor Edwards, R. (2021). Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease. PLoS ONE, 16(1), e0244851. https://doi.org/10.1371/journal.pone.0244851

• Journal Article Type: Article
• Acceptance Date: Dec 17, 2020
• Online Publication Date: Jan 14, 2021
• Publication Date: Jan 14, 2021
• Deposit Date: Jan 15, 2021
• Publicly Available Date: Jan 15, 2021
• Journal: PLOS ONE
• Publisher: Public Library of Science
• Volume: 16
• Issue: 1
• Pages: e0244851
• DOI: https://doi.org/10.1371/journal.pone.0244851
• Publisher URL: https://doi.org/10.1371/journal.pone.0244851
• Related Public URLs: https://journals.plos.org/plosone/
• Additional Information: Additional Information : ** From PLOS via Jisc Publications Router ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ **Journal IDs: eissn 1932-6203 **Article IDs: publisher-id: pone-d-20-16557 **History: published_online 14-01-2021; collection 2021; accepted 17-12-2020; submitted 01-06-2020; Grant Number: 737964; Grant Number: 285758