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

by Marie Allesen and Cecilie Christiansen

Introduction

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

Methods

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

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 section

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

*Applies to ‘Healing ulcer’ only. Number of weeks after week 4. Estimates truncated at 1 year. †Data from Leaper et al. 201615. **Estimated from model.

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).

Conclusion

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.

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