Find your Coloplast country website

Cost-effective use of silver dressings for the treatment of hard-to-heal chronic venous leg ulcers


Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the health care system. The pathogenesis of venous leg ulcers includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. Here is presented an analysis of the cost-effectiveness of Biatain® Ag using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers16


A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver dressings compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healedulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. If ulcers did not improve during the four-week period,the patients were assumed to be referred to specialist care (Figure 1). To estimate the cost of wound management, data was sourced from the clinical trial data in the published meta-analysis of four RCTs on Biatain Ag, described in the previous section15

Framework for health economic model. The patient cohort consisted of 659 hard-to-healvenous leg ulcers.

Figure 1

Clinical outcomes

As shown in Table 1, a higher proportion of ulcers treated with the silver dressing healed during thefour-week period compared with ulcers treated with non-silver dressings (7.6% compared with 3.4%).The proportion of healing ulcers was also higher in the group treated with silver dressings comparedwith non-silver dressings (79.4% compared with 72.1%). A lower proportion of patients treated withsilver dressings had no improvement in ulcer area during the four weeks than patients treated withnon-silver dressings (13.0% compared with 24.5%).

Patient outcome after four weeks of treatment with Biatain® Ag compared with non-silverdressings in pooled data set from four clinical trials.

Table 1

Economic results

The economic evaluation of four weeks of silver treatment in primary care compared with non-silvertreatment estimated the group treated with silver to be more expensive (£623.52) than non-silvertreatment (£533.60). However, a higher proportion of patients treated with silver had ulcers withcomplete healing or healing ulcers, and therefore the estimated average time-to-healed ulcer waslower (13.8 weeks) compared with non-silver treatment (16.7 weeks). Hence, the average totaltreatment cost per patient was lower for the silver dressing (£1,326.57) compared with non-silvertreatment (£1468.14) with a total cost saving of £141.57 (Table 1).


Based on a health economic model, where clinical data was sourced from a published meta-analysis, itwas shown that when patients with hard-to-heal venous leg ulcers are allocated to an initial four-weektreatment using silver dressings there can be associated cost savings (£141.57) compared withpatients who are treated with non-silver dressings. In addition, patients treated with silver dressingshad wound closure approximately 3 weeks before. Thus, the use of silver dressings improves healingtime and can lead to overall cost-savings. These results can be used to guide health care decisionmakers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronicvenous leg ulcers.

Reference list

See full list of references

1. International Wound Infection Institute (IWII). Wound infection in clinical practice. Wounds International. 2016.

2. Coloplast A/S, ReD associates. Data on file. 2014.

3. Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, et al. Consensus guidelines for the identification and treatment ofbiofilms in chronic nonhealing wounds. Wound Repair and Regeneration. 2017;25(5):744-57.

4. World Union of Wound Healing Societies (WUWHS). Florence Congress, Position Document. Management of biofilm. 2016.

5. Appropriate use of silver dressings in wounds. An expert working group consensus. International consensus. London; 2012.

6. Lansdown AB. A review of the use of silver in wound care: facts and fallacies. British Journal of Nursing. 2004;13(6):s6-19.

7. Rodriguez-Arguello J, Lienhard K, Patel P, Geransar R, Somayaji R, Parsons L, et al. A Scoping Review of the Use of Silver-impregnatedDressings for the Treatment of Chronic Wounds. Ostomy Wound Management. 2018;64(3):14-31.

8. Dissemond J, Bottrich JG, Braunwarth H, Hilt J, Wilken P, Munter KC. Evidence for silver in wound care - meta-analysis of clinical studiesfrom 2000-2015. Journal of the German Society of Dermatology. 2017;15(5):524-35.

9. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers.Cochrane Database of Systematic Reviews. 2018(6):1-289.

10. Münter KC, Beele H, Russell L, Crespi A, Grochenig E, Basse P, et al. Effect of a sustained silver-releasing dressing on ulcers with delayedhealing: the CONTOP study. Journal of wound care. 2006;15(5):199-206.

11. Jørgensen B, Price P, Andersen KE, Gottrup F, Bech-Thomsen N, Scanlon E, et al. The silver-releasing foam dressing, Contreet Foam,promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial. International wound journal. 2005;2(1):64-73.

12. Rayman G, Rayman A, Baker NR, Jurgeviciene N, Dargis V, Sulcaite R, et al. Sustained silver-releasing dressing in the treatment of diabeticfoot ulcers British Journal of Nursing. 2004;14(2);109-14.

13. Humbert P, Zuccarelli F, Debure C, Vendeaud Busquet F, Bressieux J-M, Bedane C, et al. Leg Ulcers Presenting Local Signs of Infection:Interest of Biatain Argent Wound Dressing. Journal des Plaies et Cicatrisations. 2006;52(9):41-7.

14. Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Molines-Barroso RJ. Clinical and microbiologicaleffectiveness of a hydropolymer alveolar dressing with ionic silver complex and silicone adhesive. Poster, EWMA(EPP021); 2018.

15. Leaper D, Münter C, Meaume S, Scalise A, Mompó NB, Jakobsen BP, et al. The Use of Biatain Ag in Hard-to-Heal Venous Leg Ulcers:Meta-Analysis of Randomised Controlled Trials. PLoS ONE. 2013;8(7):e67083.

16. Jemec GB, Kerihuel JC, Ousey K, Lauemoller SL, Leaper DJ. Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-HealChronic Venous Leg Ulcers. Plos One. 2014;9(6):e100582.

17. Mouës C, Heule F, Legerstee R, Hovius S. Five Millennia of Wound Care Products - What is New? A Literature Review. Ostomy WoundManagement. 2009;55(3):16-8.

18. Sibbald R, Williamson D, Orsted H, Campbell K, Keast D, Krasner D, et al. Preparing the Wound Bed - Debridement, Bacterial Balance, andMoisture Balance. Ostomy Wound Management. 2000;46(11):14-35.

19. Adderley UJ. Managing wound exudate and promoting healing. British Journal of Community Nursing. 2010;15(3):15-20.

20. Christiansen C, Huniche GB, Allesen-Holm M. In vitro evaluation of a silver foam dressing with and without silicone adhesive againstbiofilms and a broad range of microorganisms. Poster, EWMA(EPP025); 2018.

21. Lansdown AB. Silver in health care: antimicrobial effects and safety in use. Current Problems in Dermatology. 2006;33:17-34.

22. Percival SL, Thomas J, Linton S, Okel T, Corum L, Slone W. The antimicrobial efficacy of silver on antibiotic-resistant bacteria isolated fromburn wounds. International wound journal. 2012;9(5):488-93.

23. Böttrich JG, Brill FHH, Dissemond J, Steinmann J, Münter KC, Schümmelfeder F, et al. A Systematic Review of the Risk of BacterialResistance to Silver. Poster, EWMA; 2018.

24. Percival SL, Woods E, Nutekpor M, Bowler P, Radford A, Cochrane C. Prevalence of Silver Resistance in Bacteria Isolated from DiabeticFoot Ulcers and Efficacy of Silver-Containing Wound Dressings. Ostomy Wound Management. 2008;54(3):30-40.

25. Kostenko V, Lyczak J, Turner K, Martinuzzi RJ. Impact of Silver-Containing Wound Dressings on Bacterial Biofilm Viability and Susceptibilityto Antibiotics during Prolonged Treatment. Antimicrobial Agents and Chemotherapy. 2010;54(12):5120-31.

26. Burger C, Lemoult S, Andersen MB. Silver release profile and antibacterial effect of a new silver foam dressing with silicone adhesive.Poster, EWMA(EPP025); 2018.

27. Malone M, Bjarnsholt T, McBain AJ, James GA, Stoodley P, Leaper D, et al. The prevalence of biofilms in chronic wounds: a systematicreview and meta-analysis of published data. Journal of wound care. 2017;26(1):20-5.

28. Bjarnsholt T. The Role of Bacterial Biofilms in Chronic Infections. Acta pathologica, microbiologica, et immunologica Scandinavica.2013;121(s136):1-58.

29. Costerton JW. Bacterial Biofilms: A Common Cause of Persistent Infections. Science. 1999;284(5418):1318-22.

30. Crone S, Garde C, Bjarnsholt T, Alhede M. A novel in vitro wound biofilm model used to evaluate low-frequency ultrasonic-assisted wounddebridement. Journal of wound care. 2015;24(2):64-72.

31. Bessa LJ, Fazii P, Di Giulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarksabout wound infection. International wound journal. 2013;12(1):47-52.

32. Yin HQ, Langford R, Burrell RE. Comparative Evaluation of the Antimicrobial Activity of ACTICOAT Antimicrobial Barrier Dressing. Journalof Burn Care & Rehabilitation. 1999;20(3):195-200.

33. ASTM E2149-13a, Standard Test Method for Determining the Antimicrobial Activity of Antimicrobial Agents Under Dynamic ContactConditions. ASTM International. 2013.

34. prEN16756 (draft). Antimicrobial wound dressings – Requirements and test methods. 2014.

35. Howell-Jones RS, Wilson MJ, Hill KE, Howard AJ, Price PE, Thomas DW. A review of the microbiology, antibiotic usage and resistance inchronic skin wounds. Journal of Antimicrobial Chemotherapy. 2005;55(2):143-9.

36. Bowler PG, Duerden BI, Armstrong DG. Wound Microbiology and Associated Approaches to Wound Management. Clinical MicrobiologyReviews. 2001;14(2):244-69.

37. Daeschlein G. Antimicrobial and antiseptic strategies in wound management. International wound journal. 2013;10 Suppl 1:9-14.

38. Thomas S. Laboratory findings on the exudate-handling capabilities of cavity foam and foam-film dressings. Journal of wound care.2010;19(5):192-9.

39. White R, Cutting KF. Modern exudate management: a review of wound treatments. Poster, EWMA(EPP025); 2018.

40. Romanelli M, Vowden K, Weir D. Exudate management made easy. Wounds International. 2010;1(2):1-6.

41. Andersen MB. Comparison of 24 hours fluid handling and absorption under pressure between four wound dressings with Ag and siliconeadhesive. EWMA(EP296); 2016.

42. Baños AM, Nogueras FI, Palomar LF. Clinical evaluation of a silver dressing in the treatment of infected and colonized ulcers. Revista deenfermería. 2008;31(3):42-8.

43. Senet P, Bause R, Jorgensen B, Fogh K. Clinical efficacy of a silver-releasing foam dressing in venous leg ulcer healing: a randomisedcontrolled trial. International wound journal. 2014;11(6):649-55.

44. Flanagan M. Wound measurement: can it help us to monitor progression to healing? Journal of wound care. 2003;12(5):189-94.

View desktop version