Clinical and Economic Burden of Autologous Skin Grafting for Nonthermal Full-Thickness Wounds Across Care Settings: A US Retrospective Claims Study.

内容摘要

The clinical and economic burden among patients with non-thermal full-thickness wounds (NFTW) resulting from trauma or surgery and undergoing autologous skin grafts is not well characterized. Assessing burden of care can inform treatment choice, evaluation of emerging wound therapies, and payer coverage decisions. Clarivate's Real-world Data Repository® national claims database between 01/01/2019 and 08/31/2024 was used to select patients aged ≥ 15 years with a primary NFTW diagnosis who underwent an autologous skin graft procedure (index). Separate cohorts were analyzed according to the site of care where the index procedure was performed (inpatient, outpatient hospital, office/clinic). Kaplan-Meier estimates of the 90-day post-index adverse outcome rates, select adjunct procedures, and select medication use were generated. All-cause 12-month healthcare resource utilization (HRU) and costs [in 2024 United States (US) dollars] were also estimated. Of the 26,117 patients with a NFTW, the mean age was 59.3 years and 43.3% were female. During the 12-month pre-index period 41.2% were smokers, 32.0% were obese, 31.8% had diabetes or diabetes-related comorbidities, and 21.5% were malnourished. Drug or alcohol abuse (15.6%), frailty (13.6%), and autoimmune diseases/immunodeficiency (10.4%) were also common. Traumatic wounds accounted for 56.1% and surgical wounds for 29.7% of all cases. Within 90 days, regrafting and graft failure occurred in 7.6% and 4.9% of the inpatient cohort, 3.4% and 3.1% of the outpatient hospital cohort, and 3.5% and 0.1% of the office/clinic cohort, respectively. Total mean annual costs were $266,231 (standard deviation (SD) = $458,484] per patient in the inpatient, $62,619 (SD = $132,510) in the outpatient hospital, and $14,261 (SD = $36,894) in the office/clinic cohorts with an average all-cohort cost of $128,959 (SD = $306,485). Patients receiving autologous skin grafts for NFTW are medically complex with high rates of complications and significant costs, highlighting the need for novel interventions or adjunct therapies to reduce the associated clinical and economic burden. Nonthermal full-thickness wounds are severe injuries that damage the skin and often require autologous skin grafts to heal. This study looked at over 26,000 people in the United States who received autologous skin grafts for non-thermal full-thickness wounds between 2019 and 2024. Many of these patients had other health problems including diabetes, obesity, or poor nutrition, which made their care more complicated. The study found that patients with non-thermal full-thickness wounds undergoing skin grafting need intense care and their average healthcare costs exceeded $128,000 over 12 months. This study suggests that new treatment approaches are needed to help reduce complications and costs.