title: Relative cost-effectiveness of a skin protectant in managing venous leg ulcers in the UK.
abstract: OBJECTIVE
  To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK.
  
  
  METHODS
  A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant.
  
  
  RESULTS
  Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53-66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p<0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37-38 nurse visits over the study period. Patients' dressings were changed, on average, every 4-5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ~£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for <10% of the cost.
  
  
  CONCLUSIONS
  Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy.
  
  
  BACKGROUND
  This study was sponsored by 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
authors.affiliation: Catalyst Health Economics Consultants, Northwood, UK. julian.guest@catalyst-health.co.uk
authors.forename: J F
authors.initials: JF
authors.lastname: Guest
authors.forename: R R
authors.initials: RR
authors.lastname: Taylor
authors.forename: K
authors.initials: K
authors.lastname: Vowden
authors.forename: P
authors.initials: P
authors.lastname: Vowden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058128:Compression Bandages; D003362:Cost-Benefit Analysis; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009779:Occlusive Dressings; D009824:Ointments; D017063:Outcome Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D006113:United Kingdom; D014647:Varicose Ulcer / Q000188:drug therapy* / Q000191:economics*; D014945:Wound Healing
chemical_list: D003879:Dermatologic Agents; D009824:Ointments