Leanne Atkin

A cost-effectiveness analysis of a hydration response technology dressing in the treatment of venous leg ulcers in the UK

OBJECTIVE Venous leg ulcers (VLUs) cause significant pain and suffering for patients. Additionally, they place considerable financial and service burden on the National Health Service (NHS). A large proportion of VLUs do not heal within the standard time frame of 16-24 weeks, resulting in static wounds which commonly have issues with increasing exudate production. As the NHS continues to face times of austerity, services need to find solutions to be able to reduce costs and release nursing time while maintaining standards of care. Cutimed Sorbion Sachet S, a hydration response technology dressing (HRTD), is a treatment option for the management of patients with a VLU. The objective of this study was to provide an update of the health economic analysis of HRTD in comparison with relevant comparators in the UK with current cost data. METHOD HRTD was compared against four different dressings, Zetuvit Plus (a super absorbent polymer dressing SAP), DryMax extra (a superabsorbent dressing, SADM), KerraMax Care (superabsorbent dressing, SAKM) and Eclypse (superabsorbent dressing, SAE) from a cost-effectiveness perspective. Clinical data were derived from literature and expert opinion. Cost input was utilised based on publicly available data and literature. The average patient in the model is assumed to be 65 years with a diagnosed VLU. It is assumed that patients in the different treatment arms have the same background mortality, hence the endpoint mortality is not included in the model. The analysis is based on a deterministic Markov model derived from Harding et al. with weekly cycles. The following assumptions are made: first, all patients start in a static health state with a non-healed but non-progressing VLU. It is assumed in the model that patients wounds can transition to a deteriorating state or one where a wound is improving or could progress. Additionally, VLUs could be healed from a progressed wound (i.e. improved wound), or they could develop into a severe wound with complications (infections) to be treated in hospitals. The time frame for the analysis was fixed for one year and no re-occurence after healing was assumed to happen. RESULTS The cost-effectiveness analysis demonstrates health economic dominance of HRDT being more effective and cost-saving against all analysed comparators. When using literature-based input values, the incrementally higher healing rates for HRDT are 11.04 months (versus SAP), 29.04 months (versus SADM), 1.68 months (versus SAKM) and 11.04 months (versus SAE). Cost savings per patient were £37.60 versus SAP, £171.68 versus SADM, £3.13 versus SAKM and £43.63 versus SAE. CONCLUSION Clinical benefits and cost savings increase when real-life practice assumptions, based on expert opinion, are included. Based on the underlying health economic model, HRDT is more effective and less costly than other comparative products in VLUs in the UK.

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management

OBJECTIVE Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.

An investigation to assess ankle mobility in healthy individuals from the application of multi-component compression bandages and compression hosiery

BackgroundAn investigation was undertaken to compare the effect of multi-component compression bandages and compression hosiery kits on individuals’ range of ankle motion whilst wearing typical and medical footwear, and barefoot.MethodsA convenience sample of 30 healthy individuals recruited from the staff and student population at the University of Huddersfield, UK. Plantarflexion/dorsiflexion range of ankle motion (ROAM) was measured in participants over 6 steps in every combination of typical, medical and no footwear; and multi-component bandages, compression hosiery and no garments.ResultsControlling for age, gender and garments, the use of typical footwear was associated with a mean increase in ROAM of 2.54° at best estimate compared with barefoot; the use of medical footwear was associated with a mean decrease in ROAM of 1.12° at best estimate compared with barefoot. Controlling for age, gender and footwear, the use of bandaging was associated with a mean decrease in ROAM of 2.51° at best estimate compared with no garments. Controlling for age, gender and footwear, the use of hosiery was not associated with a significant change in ROAM compared with no garments.ConclusionsBandages appear to restrict ROAM more than hosiery when used in conjunction with a variety of footwear types.