Cost‐effective faster wound healing with a sustained silver‐releasing foam dressing in delayed healing leg ulcers – a health‐economic analysis

Abstract

The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous leg ulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service.

A review of the applications of the hydrofiber dressing with silver (Aquacel Ag®) in wound care

“…Aquacel Ag ® was also evaluated for the treatment of chronic wounds,29,30,38,39 which have an increased bacterial burden that can impair healing, albeit without all the clinical signs of infection. Silver can provide a mechanism for controlling the wound bacterial burden.…”

Use of Silver in the Prevention and Treatment of Infections: Silver Review

“…There was no significant difference between the groups in wound healing at 12 weeks, but the silver dressings were associated with much higher costs [59]. However, a comparison study found a silver-releasing foam dressing to be more cost-effective than other silver-containing products, including an ionic silver hydrofiber dressing and a silverimpregnated activated charcoal dressing [60]. Other concerns related to use of silver dressings are a greater frequency and number of visits and longer total duration of wound care, which may increase costs [61].…”

“…With the advent of antibiotics circa World War II, the use of silver for many of these functions declined, only to be revived in the 1960s by Moyer and Fox, as described below [reviewed in 3]. Several studies failed to show benefit in overall wound healing Some studies favor use of silver-releasing foam dressing [55,60,62], whereas others show higher cost [59,61] Current data do not support routine use of silver for this application…”

Silver dressings – do they work?

“…In a cost effectiveness analysis (supported by a grant from the manufacturers of Contreet Foam) using indirect comparisons between Contreet Foam, Aquacel Ag, Actisorb Silver and iodoflex (antimicrobial with gauze) in patients with delayed healing leg ulcers, the cost per percentage reduction in wound area over 4 weeks was assessed 19. The authors stated that they used this analysis because no studies were available following patients to complete healing (which the authors indicated occurs in 50–75% of ulcers within 1 year and 71–87% by 2 years).…”