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Dermagraft is contraindicated and has no proven value in infected ulcers and ulcers with sinus tracts.: The use of Tisseel is considered integral to the surgery and is not separately reimbursed.
The human keratinocytes and fibrobasts are derived from neonatal forsekins.Venous ulceration, a relatively common manifestation of venous hypertension, is often refractory to conservative treatment and difficult to treat.Human skin equivalents appeared to promote wound healing in 3 ways: Rice et al (2015) used Medicare claims data to assess the real-world medical services utilization and associated costs of Medicare patients with diabetic foot ulcers (DFUs) treated with Apligraf or Dermagraft (human fibroblast-derived dermal substitute (HFDS)) compared with those receiving conventional care (CC).Consequently, BLCC and HFDS patients had per-patient average healthcare costs during the 18-month follow-up period that were lower than their respective matched CC counterparts (-53 BLCC, -91 HFDS).This study is limited by the fact that it is based upon administrative claims data.DFU patients were selected from Medicare de-identified administrative claims using ICD-9-CM codes.
The analysis followed an 'intent-to-treat' design, with cohorts assigned based on use of (1) BLCC, (2) HFDS, or (3) CC (i.e., ≥1 claim for a DFU-related treatment procedure or podiatrist visit and no evidence of skin substitute use) for treatment of DFU in 2006-2012.For nerve wraps or cuffs (e.g., Avance nerve graft, Axogen,2 nerve wrap, Integra Neural Wrap, Neuro Matrix collagen nerve cuff, and Neuro Mend collagen nerve wrap), see CPB 416 - Nerve Grafting: Selected Indications.For Aetna’s policy on systemic and topical hyperbaric oxygen, see CPB 0172 - Hyperbaric Oxygen Therapy (HBOT).The authors stated that its findings relied on accuracy of diagnosis and procedure codes contained in the claims data, and did not account for outcomes and costs beyond 18 months after treatment initiation.Apligraf was shown in clinical trials to heal even longstanding (greater than 1 year's duration) venous leg ulcers more effectively and faster than compression therapy alone.In addition, the product is not considered medically necessary in persons with an inadequate blood supply to the involved foot.