Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-Heal Chronic Venous Leg Ulcers

Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healed ulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (£141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs

Designing functional medical products for children with cancer

This paper details how Quality Function Deployment (QFD) has been used to develop a tactile advanced product for a medical application. Innovative experimental and industrial research was undertaken, leading to the design of a child-focused ‘Wiggle Bag’, which can be used to safely harness and reduce infection at the site of a venous catheter placed in the chest wall of long-term child cancer sufferers. Children with cancer regularly have long-term central venous catheters inserted through their upper chest wall to deliver medication. They can result in medical issues, particularly infections or accidental removal, but also discomfort for the children, particularly when sleeping. The research uses an abductive approach, triangulating various research strategies, including questionnaires, focus groups and interviews from parents, carers and medical personnel. QFD was used to bring together the key findings from the primary data analysis to establish an ergonomic design criteria and inform the product development

Perioperative warming theraphy for preventing surgical site infection in adults undergoing surgery

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions

Sensitivity analysis. Change in incremental cost (£) per patient (silver treatment versus non-silver treatment) when changing key assumptions ±50%.

<p>The figure includes the assumptions that ‘Dressing change per week. Normal wound’; ‘Cost of primary care visit. Normal wound’; ‘Cost of silver dressing’; have the highest impact on the incremental cost per patient. For example if the ‘cost of silver dressing’ was higher (turquoise bar) the incremental cost per patient would be reduced, nevertheless, even if the price of silver dressing is 50% more expensive the incremental cost would remain below zero (i.e. be cost-saving).</p

Framework for health economic model. The patient cohort consisted of 659 patients with hard-to-heal VLUs.

<p>Framework for health economic model. The patient cohort consisted of 659 patients with hard-to-heal VLUs.</p

Patient outcome after four weeks silver dressing compared with non-silver wound management in pooled data set from four clinical trials.

<p>*Applies to 'Healing ulcer' only. Number of weeks after week 4. Estimates truncated at 1 year.</p>†<p>Data from meta-analysis <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100582#pone.0100582-Leaper2" target="_blank">[22]</a>.</p>‡<p>Unpublished data.</p

Comparison of cost of wound management (£) using a four week silver treatment compared with non-silver treatment in primary care.

<p>*Based on linear extrapolation of wound closure during first 4 weeks observed in the meta-analysis <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100582#pone.0100582-Leaper2" target="_blank">[22]</a>.</p><p>**Unit cost of initial assessment/follow up (From <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100582#pone-0100582-t001" target="_blank">Table 1:</a> £103.47 initial assessment + £84.04 follow-up visit + £29.95 ABPI assessment + £5.50 Duplex scan (10% of patients assumed to be referred to duplex scan)).</p><p>***Total healing time was assumed equal to average time to healing in patients with non-expanding wound estimated in the meta-analysis (minimum of healing time estimated for silver treatment respectively non-silver treatment arm). The split between weeks with complicated wound and normally healing wound was equal in both silver treatment and non-silver treatment arms.</p>†<p>High frequency dressing change (4 times/week).</p>‡<p>Low frequency dressing change (2 times/week).</p

Clinical and economic burden of surgical site infections in inpatient care in Germany: A retrospective, cross-sectional analysis from 79 hospitals

Background Surgical site infections (SSI) present a substantial burden to patients and healthcare systems. This study aimed to elucidate the prevalence of SSIs in German hospitals and to quantify their clinical and economic burden based on German hospital reimbursement data (G-DRG). Methods This retrospective, cross-sectional study used a 2010–2016 G-DRG dataset to determine the prevalence of SSIs in hospital, using ICD-10-GM codes, after surgical procedures. The captured economic and clinical outcomes were used to quantify and compare resource use, reimbursement and clinical parameters for patients who had or did not have an SSI. Findings Of the 4,830,083 patients from 79 hospitals, 221,113 were eligible. The overall SSI prevalence for the study period was 4.9%. After propensity-score matching, procedure type, immunosuppression and BMI ≥30 were found to significantly affect the risk of SSI (pInterpretation The dataset offers robust information about the “real-world” clinical and economic burden of SSI in hospitals in Germany. The significantly increased mortality of patients with SSI, and their underfunding, calls for a maximization of efforts to prevent SSI through the use of evidence-based SSI-reduction care bundles