Clinical and cost efficacy of advanced wound care matrices in the treatment of venous leg ulcers: a systematic review
Venous leg ulcers (VLUs) are hard-to-heal, recurrent and challenging to treat. Advanced wound care matrices (AWCMs) have been developed to supplement conventional therapies. These costly AWCMs warrant careful comparison as healthcare expenditures are subjected to increasing scrutiny.
This study was designed to compare AWCMs in their ability to heal VLUs and their cost efficacy through a systematic review of randomised controlled trials (RCTs).
An organised search of Medline, Cochrane Library, Central and CINAHL databases identified RCTs that compared AWCMs to standard compression therapy in the healing of VLUs. Bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Eight studies analysing bilayered skin substitute (BSS) (Apligraf), dehydrated human amnion/chorion membrane (dHACM) (Epifix), human fibroblast-derived dermal substitute (HFDDS) (Dermagraft), extracellular wound matrix (ECM) (Oasis), advanced matrix (AM) (Talymed) and matrix wound dressing (MWD) (Promogran) met the inclusion criteria.
Four studies reported significant improvement over standard therapy: BSS, dHACM, ECM and AM. Incremental cost per additional successful treatment was determined for each trial, ranging from $2593 (MWD) to $210,800 (HFDDS).
Our consolidated analysis of eight major RCTs of AWCMs in the treatment of VLUs revealed a great variation in clinical and cost efficacy among these products. The included trials were inconsistent in methodology, and these limitations should be noted, but, in the absence of RCTs to compare these products, our systematic review may serve as a guide for practitioners who seek to optimise wound healing while considering cost efficacy.
Venous leg ulcers (VLUs) are a prevalent condition, affecting as much as 1% of the population, and up to 4% of individuals over 65 years of age.1 They have a deleterious impact on lifestyle,2 are hard-to-heal and recurrent in nature, and are challenging to treat successfully.3
The treatment of VLUs accounts for a significant portion of healthcare expenditure in the US, with cost exceeding an estimated $2.5–3.5 billion annually.4 This cost is driven by provider care, compression therapy regimens, antibiotic therapy, procedures such as venous ablation and attempted wound closures, and dressings such as advanced wound care matrices (AWCMs). This does not include the economic impact of lost work days and productivity. High recurrence rates frustrate both the provider and patient and further stress cost of care to the healthcare system.
Conventional therapy for VLUs is multifaceted in nature. Wound cleansing and debridement should be performed at the initial evaluation and as needed at each subsequent dressing change in order to provide the proper environment for healing. In addition to products used for cleansing, topical dressings, such as alginates and foams, are supportive for maintenance of this optimal healing environment.5,6
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