A systematic review of cost-effectiveness analyses of wound interventions reveals optimal treatments

Full text here:  A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

This intriguing model may, as it evolves, help to cut through complexity toward core truths in interdisciplinary care and technology in wound healing. In summary, 59 studies were reviewed. As an example, here is a review of 16 diabetic foot ulcer studies:

Cost-effectiveness analysis (CEA) outcomes for diabetic ulcers (n = 16)
CEA (Original year of values) Treatment vs. Comparator ICER summary/estimate [2013 US$] Unit of effectiveness Incremental cost [2013 US$] Incremental effectiveness
Abidia 2003 (2000) [48] HBOT vs. control Dominant Additional wound healed −7,596 0.625
Apelqvist 1996 (1993)[49] Cadexomer iodine ointment vs. standard treatment Dominanta Additional wound healed −119 0.183
Edmonds 1999 (1996)[50] Filgrastim vs. placebo Dominanta,b Hospital-free day gained −7,738 7.5
Guo 2003 (2001) [51] HBOT + SC vs. SC alone 3508a QALY gained 2,137 0.609
Habacher 2007 (2001)[52] Intensified treatment vs. SC Dominanta Patient-year gained −7,625 2.97
Horswell 2003 (1999) [53] Staged management diabetes foot program vs. SC Dominanta Foot-related hospitalization avoided −7,848 0.41
Jansen 2009 (2006) [54] Ertapenem vs. Piperacillin/Tazobactam Dominanta Lifetime QALY gained −822 0.12
Jeffcoate 2009c (2007)[55] Hydrocolloid (Aquacel) vs. antiseptic (Inadine) 1449a Additional wound healed 14 0.01
Jeffcoate 2009c (2007)[55] Antiseptic (Inadine) vs. non-adherent dressing 1590a Additional wound healed 80 0.05
McKinnon 1997 (1994)[56] Ampicillin/sulbactam vs. imipenem/cilastatin Dominanta Hospitalization day avoided −5,891 3.5
Persson 2000 (1999) [57] Becaplermin plus GWC (unspecified) vs. GWC alone Dominanta Ulcer-free month gained −628 0.81
Piaggesi 2007 (2006) [58] Total contact casting vs. Optima Diab device 8,578 Additional wound healed 858 0.1
Redekop 2003 (1999) [59] Apligraf (skin substitute) + GWCd vs. GWC alone Dominanta Ulcer-free month gained −1,223 1.53
Allenet 2000 (1998) [60] Dermagraft (human dermal replacement) vs. SC 70,961a Additional wound healed 12,652 0.178
Ghatnekar 2002 (2000)[61] Promogran dressing plus GWCe vs. GWC alone Dominanta Additional wound healed −294 0.042
Ghatnekar 2001 (1999)[62] Becaplermin gel (containing recombinant human platelet-derived growth factor) plus GWCf vs. GWC alone Dominanta Ulcer-free month gained −794 0.81
Hailey 2007 (2004) [63] HBOT + SC vs. SC alone Dominant QALY gained −9,337 0.63

GWC, Good wound care; HBOT, Hyperbaric oxygen therapy; ICER, Incremental cost-effectiveness ratio; QALY, Quality-adjusted life-year; SC, Standard care; US$, United States dollars.

aDenotes the higher quality studies (Drummond score ≥8).

b“Patient selection may have occurred during the in-hospital stay where more control patients experienced a bad vascular condition requiring the more costly interventions”.

cMultiple comparisons are reported.

dGWC, “the best wound care available and consists mainly of offloading, debridement, and moist dressings”.

eGWC, “sharp debridement (if necessary) and wound cleansing. In the GWC alone arm, the primary dressing was saline-soaked gauze and the secondary gauze and tape”.

fGWC, “sharp debridement to remove callus, fibrin and necrotic tissue; moist saline dressing changes every 12 hours; systematic control of infection, if present; glucose control; and offloading of pressure”.

Tricco et al.

Tricco et al. BMC Medicine 2015 13:90   doi:10.1186/s12916-015-0326-3

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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