The cost-effectiveness of wound management protocols of care

Abstract

A European cost-effectiveness study has been conducted using published clinical trial data from multinational studies on chronic venous leg ulcers and pressure sores. Data relevant to UK chronic wound management practice have been extracted and are presented here. A total of 15 pressure sore studies involving 519 wounds, and 12 leg ulcer studies involving 843 ulcers were used in a pooled analysis. The study objectives included the calculation of comparative costs in £ sterling for three different treatment protocols for each wound type. The protocols have been adapted for UK clinical practice in both hospital and community settings and are based on primary dressings and nurse time costs, wound cleansing and debridement, the use of fillers, and compression as appropriate. The focus of the study has been the cost-effectiveness comparison (as measured by cost per healed wound) of two modern dressings — Granuflex® hydrocolloid dressing and Apligraf® skin replacement — and traditional gauze dressings in the treatment of venous leg ulcers and, in the case of pressure sores, comparison of Granuflex® and Comfeel® hydrocolloid dressings and traditional saline gauze dressings. The choice of dressings studied was dictated by the available published literature. The construction of treatment protocols and assumptions on treatments otherwise missing from published papers has been achieved through the use of an expert panel. Results show Granuflex® to be 50% more cost-effective, at £422 per healed wound, than Comfeel® (£643) and 500% more so than saline gauze (£2548) in the treatment of pressure sores. Granuflex® at £342 was also more cost-effective than gauze (£541) or Apligraf® (£6741) in the treatment of venous leg ulcers. These data will provide a valuable adjunct to published clinical evidence, offering further information upon which carers can base their choice of wound dressing.