Academic journal article Applied Health Economics and Health Policy

Economic Evaluations of Guideline-Based or Strategic Interventions for the Prevention or Treatment of Chronic Wounds

Academic journal article Applied Health Economics and Health Policy

Economic Evaluations of Guideline-Based or Strategic Interventions for the Prevention or Treatment of Chronic Wounds

Article excerpt

Published online: 11 March 2014

© The Author(s) 2014. This article is published with open access at


Background Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce.

Objectives Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management.

Data Sources Data sources included PubMed, Scopus, HTA, and NHS EED.

Study Eligibility Criteria, Participants, and Interventions We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated.

Study Appraisal and Synthesis Methods Study and model characteristics and outcomes were extracted into predesigned tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers.

Results A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws.

Limitations Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies.

Conclusions and Implications of Key Findings Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.

1 Introduction

Chronic wounds are those wounds that fail to heal in a timely manner or become stuck in the inflammatory phase of healing [1]. In developed countries, the incidence of chronic wounds has been growing in recent years and likened to a 'silent epidemic' [2]. The increase in the incidence of chronic wounds is due to both the aging of populations (longer lifespan) and the concurrent increase in comorbidities, such as diabetes, obesity, venous hypertension, and peripheral vascular disease [2, 3].

The most common types of chronic wounds-venous leg ulcers (VLUs), diabetic foot ulcers (DFUs), and pressure ulcers (PUs)-and their current treatments often mean that employed patients cannot work until their wounds are healed. For example, individuals with DFUs are often forced to change their nature of employment or take time offwork, and can become disabled and unable to work [4]. Social contact and mobility are also frequently impacted, leading to decreased quality of life [5]. While in the last two decades advanced therapeutics have been developed as adjunct treatments, the level of evidence for their efficacy is often poor, as exemplified by a recent review of advanced VLU treatments conducted by researchers at The Johns Hopkins University Evidence-Based Practice Center [6]. Most importantly, even though many guidelines for the management of chronic wounds have been published (clinical practice guidelines [CPGs]), too many patients still do not receive the fundamental wound care and treatment described in the guidelines. According to one professional group examining the problem for VLUs (Group IV of the Pacific Vascular Symposium 6), there are too many guidelines on VLUs from too many sources; coordinated integration is difficult; and most critically, there is a need to unify evidence-based guidelines to facilitate implementation [7]. …

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