I have blogged a lot about the problems in the CTP/skin substitute industry. If a product is say, 10 times more expensive than another one, then it needs to be 10 times better, right? Otherwise, why is it more expensive? (Pretend that making a profit off of the cost of the product is NOT a reason for the differences in price, since anyone failing to provide truthful information to Medicare about the amount of money they actually paid for a product so as to profit off the product itself would be committing a crime. But, I digress . . .)
I can’t understand why products — all of which made from human placenta (often in the same laboratories) could vary so much in price. But let’s leave that question aside for now. Let’s ask instead how much these products are WORTH. What is the cost effectiveness of CTPs/skin subs?
The prospective trials of various amniotic products have enrolled relatively superficial diabetic foot ulcers (DFUs) in relatively healthy patients. Don’t bother telling me that they work in much more serious ulcers if you can’t prove it. Coverage policies more or less mirror the inclusion criteria of the prospective trials. Assuming that all these products result in the same percentage of healed DFUs, (and there’s no comparative effectiveness data to tell me otherwise), what would a product need to DO to a superficial DFU in order to make it worth being even ten times more expensive?
Since this was a health economic question, I asked Dr. Marissa Carter to help me figure it out. She and I decided to figure it out using an economic model that she had previously developed to answer the question: How much is healing a superficial diabetic foot ulcer “worth” from a health economic standpoint? And what would a CTP/skin sub need to do to justify a price tag that is more than, say, $450/cm2?
Check out our just released paper, “Counting the Cost of Cellular and/or Tissue Based Products in Diabetic Foot Ulcers: Is There a Justifiable Price Limit Per Square cm?” for the complete answer. Spoiler alert, to justify the crazy high prices of some CTP/skin subs, the product would need to cure diabetes or bring sight to the blind to be worth the price. Now my question is, how can using high priced CTPs be justified?
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
It’s indeed troubling that CTP products processed from donated placenta tissue are priced so high, driven by profit models. The allowance of rebates by MACs raises ethical concerns and kickbacks to induce profit first models. Increased oversight from the OIG would be beneficial in addressing these issues and ensuring fair practices in the industry.