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Table 7 Cost-effectiveness analysis (CEA) outcomes for venous ulcers (n = 24)

From: A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types

CEA (Original year of values) Treatment vs. Comparator ICER summary/estimate [2013 US$] Unit of effectiveness Incremental cost [2013 US$] Incremental effectiveness
Augustin 1999 (1989) [22] Hydrocolloid dressing vs. Vaseline gauze dressing Dominant Ulcer-free week gained −3,362 1.3
DePalma 1999 (1998) [23] Thera-boot vs. Unna’s boot Dominant Ulcer-free week gained −601 1.71
Glinski 1999 (1998) [24] Micronized purified flavonoid fraction + SC vs. SC alone Dominanta Additional wound healed −714 0.19
Gordon 2006 (2005) [25] Community leg club vs. community home nursing 488a Additional wound healed Not reported Not reported
Guest 2012b (2010) [26] NSBF vs. DBC 18a Percent additional reduction of ulcer area 146 8
Guest 2012b (2010) [26] NSBF vs. no skin protectant 1a Percent additional reduction of ulcer area 17 22
Guest 2012b (2010) [26] DBC vs. no skin protectant Dominanta Percent additional reduction of ulcer area −129 14
Iglesias 2006 (2004) [27] Pentoxifylline plus compression vs. placebo plus compression Dominanta QALY gained −213 0.01
Iglesias 2004 (2001) [28] Four-layer bandage vs. short-stretch bandage Dominanta QALY gained −566 0.02
Jull 2008 (2005) [29] Manuka honey dressing vs. UC Dominanta,c Additional wound healed −48 0.06
Junger 2008 (2007) [30] Low-frequency pulsed current (Dermapulse) vs. placebo More costly & more effectived Percent additional reduction of ulcer area Not reported Not reported
Kerstein 2000b (1995) [31] Hydrocolloid dressing plus compression hosiery vs. Unna’s boot Dominant Additional wound healed −6,748 0.18
Kerstein 2000b (1995) [31] Unna’s boot vs. saline gauze plus compression hosiery More costly & more effectived Additional wound healed Not reported Not reported
Kikta 1988 (1987) [32] Unna’s boot vs. hydrocolloid (DuoDERM) Dominanta Additional wound healed −209 0.32
Michaels 2009 (2007) [33] Antimicrobial silver-donating dressings vs. low-adherent dressings 917,298a QALY gained 183 0.0002
Morrell 1998 (1995) [34] Community leg ulcer clinics using four-layer compression bandaging vs. home nursing UC 7a Ulcer-free week gained 44 5.9
O’Brien 2003 (2000) [35] Four-layer bandage vs. UC Dominanta Increase in healing rate −42 0.2
Oien 2001 (1997) [36] Pinch grafting in primary care vs. pinch grafting in hospital Cost saving & same effectiveness Additional wound healed −14,075 0
Sibbald 2001 (1997) [37] Skin substitute (Apligraf) plus four-layer bandage vs. four-layer bandage only 6095a Additional wound healed 457 0.075
Taylor 1998 (1987) [38] Four-layer high-compression bandaging vs. UC Dominanta Additional wound healed −659 0.095
Ukat 2003 (2002) [39] Multilayer elastic bandaging (Profore) vs. short-stretch bandaging Dominanta Additional wound healed −1,198 0.08
Watson 2011 (2007) [40] Ultrasound plus SC vs. SC alone Dominateda QALY gained 371 −0.009
Pham 2012 (2009) [41] Four-layer bandaging vs. short-stretch bandaging 43,918a QALY gained 395 0.009
Schonfeld 2000 (1996) [42] Apligraf (Graftskin) vs. Unna’s Boot Dominanta Ulcer-free month gained −13,883 2.85
Simon 1996 (1993) [43] Community leg ulcer clinic vs. UC clinic Dominant Additional wound healed −1,826 0.22
Carr 1999 (1998) [44] Four-layer compression bandaging (Profore) vs. UC Dominanta Additional wound healed −1,289 0.13
Guest 2009 (2007) [45] Amelogenin plus compression therapy vs. compression therapy only Dominanta QALY gained −835 0.054
  1. DBC, Durable barrier cream; ICER, Incremental cost-effectiveness ratio; NSBF, No sting barrier film; QALY, Quality-adjusted life-year; SC, Standard care; UC, Usual care; US$, United States dollars.
  2. aDenotes the higher quality studies (Drummond score ≥8).
  3. bMultiple comparisons are reported.
  4. cICER was mostly due to an extra 3 patients hospitalized in control group… “probably due to random variation”. If remove these costs, the dominance is reversed in favor of UC.
  5. dUnable to calculate specific ICER for these 2 studies because the data was not reported for all treatment arms or presented in a figure only but the overall result (more costly & more effective) was reported.
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BMC Medicine

ISSN: 1741-7015

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