Skin Substitutes for Adults With Diabetic Foot Ulcers and Venous Leg Ulcers:
A Health Technology Assessment
This superb review courtesy of colleagues at Ontario Health.
Skin Substitutes for Adults With Diabetic Foot Ulcers and Venous Leg Ulcers: A Health Technology Assessment
What Is This Health Technology Assessment About?
Wounds such as diabetic foot ulcers and venous leg ulcers can be difficult to heal. Diabetic foot ulcers are a common complication of diabetes. They form because of pressure or repetitive irritation to the skin tissue on the foot, which then breaks down, exposing the layers underneath. Venous leg ulcers are sores on the leg that are very slow to heal, usually because of impaired blood circulation in the veins of the leg.
Diabetic foot ulcers and venous leg ulcers are usually treated with traditional dressings (for example, absorbent dressings and antiseptic dressings). People with diabetic foot ulcers should also receive an offloading device (a device that relieves pressure on the foot, such as a cast or special shoe). People with venous leg ulcers should receive compression therapy (special stockings that provide support to the veins in the leg). Skin substitutes are a new treatment. They provide temporary or permanent coverage of open skin wounds. They can be beneficial when traditional dressings do not work well enough. Skin substitutes work by mimicking the properties of normal skin.
This health technology assessment looked at how safe, effective, and cost-effective skin substitutes are for adults with diabetic foot ulcers and venous leg ulcers. It also looked at the budget impact of publicly funding skin substitutes and at the experiences, preferences, and values of people with diabetic foot ulcers and venous leg ulcers.
What Did This Health Technology Assessment Find?
In adults with diabetic foot ulcers and venous leg ulcers that are difficult to heal, skin substitutes combined with standard care are more effective in promoting complete wound healing than standard care alone.
Compared with standard care alone, the cost-effectiveness of skin substitutes plus standard care is uncertain in people with diabetic foot ulcers and highly unlikely in people with venous leg ulcers. We estimate that publicly funding skin substitutes over the next 5 years would cost an additional $0.17 million in year 1 to $1.2 million in year 5 for people with diabetic foot ulcers, and from $1 million in year 1 to $7.7 million in year 5 for people with venous leg ulcers.
People with diabetic foot ulcers and venous leg ulcers we spoke with generally felt positively about the potential use of skin substitutes to heal their wounds. Barriers to access include the limited use of skin substitutes across Ontario, lack of knowledge of skin substitutes among people with these conditions, and cost.
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