Real-world outcomes of cellular, acellular, and matrix-like products (CAMPs) in Stage 3 pressure injury ulcers: A matched Medicare claims analysis (2016–2024)

Abstract

Background: Stage 3 pressure injuries (PIs) are full-thickness wounds associated with high morbidity, frequent infection-related complications, and substantial healthcare utilization in adults with compromised mobility. Real-world outcomes of cellular, acellular, and matrix-like products (CAMPs) for Stage 3 PIs in Medicare populations have not been well characterized.

Methods: We conducted a retrospective, matched-cohort study using Medicare claims data (2016–2024). Stage 3 PI ulcer treatment episodes were constructed using a 90-day clean period (defined as ≥90 days without wound-related services) and a 90-day episode definition and evaluated in a hospital outpatient department (HOPD)/inpatient-only sample. Episodes receiving CAMPs (identified by Q- and A- Healthcare Common Procedure Coding System (HCPCS) codes) were matched 1:1 to standard-of-care (SOC) episodes (which included sharp debridement without CAMPs) using a prespecified set of exact and range-based covariates including demographics, comorbidity burden, PI location markers, and timing measures. Outcomes included episode characteristics, complications (including sepsis), healthcare utilization, costs, and mortality (death within 90 days of episode end). Two minimum-duration cohorts were analyzed (90 and 120 days).

Results: For the 90-day minimum cohort (n=7223 matched episodes per group), CAMP episodes had lower mean PI-associated spending ($36,397 vs $39,886; p=0.0003) and lower mean total all-cause spending ($46,905 vs $50,686; p=0.0006). Compared with SOC, CAMP episodes were associated with lower complications and healthcare resources utilization, including lower sepsis (26.1% vs 36.1%; p<0.0001), lower major amputation (2.2% vs 3.1%; p=0.0004), fewer emergency department (ED) visits (1.34 vs 2.04; p<0.0001) and inpatient visits (1.52 vs 2.24; p<0.0001), and lower mortality (17.8% vs 22.3%; p<0.0001). Episode length was longer with CAMPs (323.8 vs 302.1 days; p<0.0001).

Findings were consistent in the 120-day minimum cohort (n=6139 per group), including lower mean total all-cause spending ($51,585 vs $56,865; p<0.0001), lower sepsis (28.8% vs 39.9%; p<0.0001), lower major amputation (2.4% vs 3.3%; p=0.0041), fewer ED visits (1.50 vs 2.29; p<0.0001) and inpatient visits (1.70 vs 2.49; p<0.0001), and lower mortality (18.4% vs 22.8%; p<0.0001). Episode length remained longer with CAMPs (359.6 vs 339.1 days; p<0.0001).

Conclusions: In matched Medicare Stage 3 PI episodes managed in the HOPD setting, CAMP use was associated with lower rates of sepsis, acute-care utilization, major amputations, mortality, total and PI ulcer–associated spending despite longer episode duration. These results further support confirmatory work incorporating greater clinical granularity and direct healing endpoints.