Cost-effectiveness analysis of Avance® allograft for the treatment of peripheral nerve injuries in the USA

Aim: Peripheral nerve injury (PNI) is a debilitating condition with significant associated morbidity, and which places a substantial socioeconomic burden on healthcare systems worldwide. Recently, allograft has emerged as a viable surgical alternative to autograft for the treatment of PNI. This study evaluated the cost effectiveness of allograft (Avance (R) Nerve Graft) compared with autograft for the peripheral nerve repair, from a US payer perspective. Methods: A Markov cohort model was developed to consider the treatment pathways followed by a patient population undergoing a single transected nerve repair with either allograft, or autograft. The marginal difference in meaningful recovery (MR) (effectiveness), and costs, between the two groups were estimated over a lifetime horizon. Deterministic and probabilistic sensitivity analyses (PSA) were performed to consider the uncertainty surrounding the base-case input parameter values and their effect on the overall incremental cost-effectiveness ratio (ICER). Results: The base-case analysis indicates that there is a small difference in the average probability of MR between the two groups (75.15% vs 70.46%; +4.69% with allograft). Allograft also results in cost savings ($12,677 vs $14,023;-$-1346 with allograft) compared with autograft. Deterministic sensitivity analysis shows that the costs of the initial surgical procedures are the main drivers of incremental cost, but that the intervention is likely to be cost saving compared with autograft regardless of the parameter variations made. Conclusion: The use of allograft with the Avance Nerve Graft has the potential to be a cost-effective alternative to autograft for the surgical treatment of PNI in the USA. Plain language summary What is this article about? This article is about finding the cost-effective way to treat peripheral nerve injuries (PNI). It looks at whether using donated nerve tissue (allograft) is a good option compared with using a patient's own nerve tissue (autograft) for treating these injuries in the United States. What were the results? The study revealed that employing allograft may present a marginally superior option. A greater proportion of individuals who underwent allograft treatment achieved improved recovery outcomes, and it also demonstrated a modest reduction in associated costs. Moreover, even when various scenarios were considered, the utilization of donated nerve tissue consistently appeared to be a favorable choice. What do the results of the study mean? The results suggest that in the US, using allograft like the Avance Nerve Graft for nerve injuries could be both cost-effective and beneficial for recovery.