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Authors Identify Cost-Effective Treatments for Complex Wounds

Results could be used to tailor improved therapies

Deciding how to treat a complex wound is like shopping at a supermarket: there’s a lot to choose from.

Complex wounds are a significant burden on patients and on the economy, costing the North American health-care system $10 billion a year. That doesn’t include indirect costs, such as patient or caregiver frustration, economic loss, and decreased quality of life.

Two new papers published April 22 by researchers at St. Michael’s Hospital in Toronto, Canada, identify which of the hundreds of available treatments are most likely to be effective and which are most likely to be cost-effective.

“There are numerous treatments available, but only a few were consistently effective or cost-effective when we looked at all the high-quality existing literature,” said lead author Andrea Ticco, PhD. “Clinicians and patients can use our results as a guide toward tailoring effective treatment. Decision-makers can use these results to maximize the use of clinically effective and resource-efficient interventions.”

Complex wounds are those that have not healed for 3 months, are infected, have compromised the viability of surrounding tissue, or are associated with some other condition that is impairing normal healing. At least 1% of people living in high-income countries will experience a complex wound in their lifetime.

The main types of complex wounds include those resulting from chronic diseases (such as diabetes or venous insufficiency), pressure ulcers, and non-healing surgical wounds.

One of the papers published in BMC Medicine looked at 99 systematic reviews of wound care treatments. Ticco and her coauthors identified several promising interventions. These included bandages or stockings (multilayer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. These results were based on the highest-quality systematic reviews.

The authors also found that topical negative pressure and vacuum-assisted closure were promising interventions for surgical wound infections, but the evidence wasn’t so strong.

In the second paper published in BMC Medicine, Ticco and her colleagues looked at 59 high-quality cost-effectiveness analyses and identified several cost-effective interventions for complex wounds. For venous ulcers, these interventions included four-layer compression bandaging vs. usual care; skin replacement vs. Unna’s boot; Unna’s boot vs. hydrocolloid; micronized purified flavonoid fraction plus usual care vs. usual care; durable barrier cream vs. no skin protectant; pentoxifylline plus compression vs. placebo plus compression; Manuka honey dressing vs. usual care; and amelogenin plus compression therapy vs. compression therapy only.

For mixed venous and venous/arterial ulcers, only hydrocolloid dressing vs. saline gauze was dominant according to high quality cost-effectiveness analyses.

For diabetic ulcers, cadexomer iodine ointment vs. usual care; filgrastim vs. placebo; intensified treatment vs. usual care; staged-management diabetes foot program vs. usual care; ertapenem vs. piperacillin/tazobactam; ampicillin/sulbactam vs. imipenem/cilastatin; skin replacement plus good wound care (GWC) vs. GWC alone; promogran dressing plus GWC vs. GWC alone; and becaplermin gel (containing recombinant human platelet-derived growth factor) plus GWC vs. GWC alone were dominant.

For pressure ulcers, moisture vapour-permeable dressing vs. gauze; advanced dressings vs. simple dressings; and hydrocolloid vs. gauze were dominant.

Sources: St. Michael’s Hospital; April 22, 2015; BMC Medicine; April 22, 2015; and BMC Medicine; April 22, 2015.

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