Cost-effectiveness analysis of the geko™ device (an NMES technology) in managing venous leg ulcers in UK healthcare settings

Abstract

This study evaluates the cost-effectiveness of the geko device a neuromuscular electro-stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two-arm randomised controlled trial, assessed wound healing rates using Kaplan-Meier curves and parametric extrapolations over a 12-month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality-adjusted life-year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health-related quality of life. The geko™ device when used adjunctively with SoC would be a cost-effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits.

Keywords: NMES; cost saving; cost‐effectiveness; venous leg ulcers; wound management.

FIGURE 1

Trial schematic detailing health economic analysis period.

FIGURE 2

Partitioned survival model. NMES, neuromuscular electro‐stimulator.

FIGURE 3

Kaplan–Meier (KM) time‐to‐healing analysis with parametric extrapolations for the control arm showing Weibull distribution. Control arm, National Health Service standard of care only.

FIGURE 4

Kaplan–Meier (KM) time‐to‐healing analysis with parametric extrapolations for the active arm showing log logistic distribution. Active arm, geko device 12 h/day plus standard of care.

FIGURE 5

Scatterplot of the incremental cost effectiveness of the active arm versus control arm following 1000 iterations of the model. Active arm, geko device 12 hrs/day plus standard of care only; control arm, National Health Service standard of care only; ICER, incremental cost‐effectiveness ratio; PSA, probabilistic sensitivity analysis; QALY, quality‐adjusted life‐year.

FIGURE 6

Visual representation of the cost‐effectiveness acceptability curve comparing the active arm across various quality‐adjusted life‐year (QALY) thresholds.