Comparative health resource utilization and cost analysis of porcine placental extracellular matrix versus standard of care and other advanced treatments in the treatment of diabetic foot ulcers in the Medicare Fee-For-Service population

Abstract

Aim: Diabetic foot ulcers (DFU) carry substantial economic and health burdens. This study compares health resource use and cost in the Medicare population receiving porcine placental extracellular matrix (PPECM)* to patients receiving standard of care (SOC)‡ and other advanced treatments (AT)†.

Methods: Medicare Research Identifiable Files containing 100% of Medicare Fee-For-Service claims for Parts A and B were assessed from 2021 through 2024. Patients with a newly diagnosed DFU were identified, and their treatment episodes were classified into three exclusive categories: PPECM, SOC, or AT. Inverse probability of treatment weighting was applied to account for baseline clinical and demographic differences. Post-treatment adjusted cohorts were then analyzed using weighted regression models to estimate differences in predicted spending and utilization across treatment groups and care settings.

Results: 225 DFU PPECM treatment episodes were selected to compare to the other groups (SOC = 111,707; AT = 5,701). Total medical spending in the post-treatment period did not show significant differences between groups. However, PPECM had a significantly lower rate of skilled nursing facility (SNF) spending than both SOC and AT, with no significant spending differences seen in other sites of care (Table 1). Weighted regression analyses further showed that PPECM patients had significantly lower utilization in inpatient hospitals compared to AT-only, and reduced utilization across physician offices, outpatient hospitals, outpatient emergency rooms, and SNFs compared to both SOC and AT (Table 2).

Conclusions: Patients with DFU treated with PPECM demonstrated lower or comparable downstream healthcare utilization relative to those treated with SOC and alternative ATs. While costs were similar between groups, differences in utilization patterns suggest that PPECM may reduce the need for repeat or subsequent medical interventions.