A Systematic Review of Economic Outcomes Associated with use of Topical Interventions for Treatment of Chronic Wounds

OBJECTIVES: A combination of interventions may be appropriate for a patient with a chronic wound. However, standard care varies by aetiology, geographical location and clinician discipline. A systematic review was undertaken to examine the economic impact of topical interventions for chronic wounds and variance associated with standard care. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of: Science Direct, National Institute for Health and Clinical Excellence Evidence search, Medline (PubMed), Centre of Reviews and Dissemination (University of York), Cochrane Database and discussion with experts and manufacturers identified the literature. Two researchers performed data extraction, with a third consulted where there were disagreements. Economic endpoints including: incremental cost-effectiveness ratio, cost-per Quality Adjusted Life Year and disease related resource use were extracted. A narrative synthesis of results and critical appraisal using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement were performed. RESULTS: 3422 records identified. After screening, 817 full text articles were judged versus inclusion and exclusion criteria. 15 studies were included: 6 economic analysis along clinical trials, and 9 modelling studies.10 studies focused on VLUs, 3 studies on DFUs and 1 on Pressure Ulcers and 1 on Chronic Wounds. Data tables for methods, results and appraisal using the CHEERS statement were completed. Quality scores ranged from 10 – 15 with a mean of 12.9. CONCLUSIONS: This review provides some evidence that topical interventions can offer cost-effective solutions for treating chronic wounds compared with standard care. Current evidence predominantly uses the endpoint of wound area reduction; evaluations using complete wound closure as primary endpoint could be more useful. This review informs decision makers and clinicians that more expensive wound care products can be cost-effective in the management of chronic wounds; in opposition to current NICE guidance to use the ‘least costly’ dressing