Presentation (CTI)

OBJECTIVES: Silver-containing dressings are known to improve complete healing rates when appropriately used in diabetic foot ulcer treatment, but their use is limited in Korean medical institutions as they are not covered by National Health Insurance Service (NHIS) reimbursement. This study aims to estimate and compare the cost-effectiveness of silver-containing dressings versus standard dressing therapies eligible for NHIS reimbursement in the treatment of diabetic foot ulcers in Korea.
METHODS: A Markov model was used to simulate the diabetic foot treatment process over 5 years in patients aged 60+, calculating costs and QALYs between two treatment strategies. Silver-containing dressings were assumed to increase complete healing rates, thereby reducing lower limb amputations and mortality. Input parameters were derived from published literature and analyses of Korean National Health Insurance Service claims data. One-way sensitivity analysis was conducted to assess the robustness of base-case results.
RESULTS: The silver-containing dressing option resulted in cost savings compared to the current standard care dressing option. The comparison option had higher treatment frequency, so there was no significant difference in intervention costs overall. One-way sensitivity analysis showed that at a cost-effectiveness threshold of 20 million KRW/QALY, the silver-containing dressing remained cost-effective compared to other dressings even when the clinical effect was reduced from RR=1.28 to RR=1.01. One-way sensitivity analysis of other input variables demonstrated the robustness of the base-case analysis.
CONCLUSIONS: Due to the characteristics of dressing products, it is difficult to conduct high-quality RCTs because blinding participants is not feasible. Even if the efficacy is significantly lower than currently reported figures, the use of silver-containing dressings is expected to be cost-effective within Korea's healthcare system.