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

Tricco, Andrea C; Cogo, Elise; Isaranuwatchai, Wanrudee; Khan, Paul A; Sanmugalingham, Geetha; Antony, Jesmin; Hoch, Jeffrey S; Straus, Sharon E

doi:10.1186/s12916-015-0326-3

Table 9 Cost-effectiveness analysis (CEA) outcomes for diabetic ulcers (n = 16)

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
Abidia 2003 (2000) [48]	HBOT vs. control	Dominant	Additional wound healed	−7,596	0.625
Apelqvist 1996 (1993) [49]	Cadexomer iodine ointment vs. standard treatment	Dominant^a	Additional wound healed	−119	0.183
Edmonds 1999 (1996) [50]	Filgrastim vs. placebo	Dominant^a,b	Hospital-free day gained	−7,738	7.5
Guo 2003 (2001) [51]	HBOT + SC vs. SC alone	3508^a	QALY gained	2,137	0.609
Habacher 2007 (2001) [52]	Intensified treatment vs. SC	Dominant^a	Patient-year gained	−7,625	2.97
Horswell 2003 (1999) [53]	Staged management diabetes foot program vs. SC	Dominant^a	Foot-related hospitalization avoided	−7,848	0.41
Jansen 2009 (2006) [54]	Ertapenem vs. Piperacillin/Tazobactam	Dominant^a	Lifetime QALY gained	−822	0.12
Jeffcoate 2009^c (2007) [55]	Hydrocolloid (Aquacel) vs. antiseptic (Inadine)	1449^a	Additional wound healed	14	0.01
Jeffcoate 2009^c (2007) [55]	Antiseptic (Inadine) vs. non-adherent dressing	1590^a	Additional wound healed	80	0.05
McKinnon 1997 (1994) [56]	Ampicillin/sulbactam vs. imipenem/cilastatin	Dominant^a	Hospitalization day avoided	−5,891	3.5
Persson 2000 (1999) [57]	Becaplermin plus GWC (unspecified) vs. GWC alone	Dominant^a	Ulcer-free month gained	−628	0.81
Piaggesi 2007 (2006) [58]	Total contact casting vs. Optima Diab device	8,578	Additional wound healed	858	0.1
Redekop 2003 (1999) [59]	Apligraf (skin substitute) + GWC^d vs. GWC alone	Dominant^a	Ulcer-free month gained	−1,223	1.53
Allenet 2000 (1998) [60]	Dermagraft (human dermal replacement) vs. SC	70,961^a	Additional wound healed	12,652	0.178
Ghatnekar 2002 (2000) [61]	Promogran dressing plus GWC^e vs. GWC alone	Dominant^a	Additional wound healed	−294	0.042
Ghatnekar 2001 (1999) [62]	Becaplermin gel (containing recombinant human platelet-derived growth factor) plus GWC^f vs. GWC alone	Dominant^a	Ulcer-free month gained	−794	0.81
Hailey 2007 (2004) [63]	HBOT + SC vs. SC alone	Dominant	QALY gained	−9,337	0.63

GWC, Good wound care; HBOT, Hyperbaric oxygen therapy; ICER, Incremental cost-effectiveness ratio; QALY, Quality-adjusted life-year; SC, Standard care; US$, United States dollars.
^aDenotes the higher quality studies (Drummond score ≥8).
^b“Patient selection may have occurred during the in-hospital stay where more control patients experienced a bad vascular condition requiring the more costly interventions”.
^cMultiple comparisons are reported.
^dGWC, “the best wound care available and consists mainly of offloading, debridement, and moist dressings”.
^eGWC, “sharp debridement (if necessary) and wound cleansing. In the GWC alone arm, the primary dressing was saline-soaked gauze and the secondary gauze and tape”.
^fGWC, “sharp debridement to remove callus, fibrin and necrotic tissue; moist saline dressing changes every 12 hours; systematic control of infection, if present; glucose control; and offloading of pressure”.

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ISSN: 1741-7015

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