title: Cost-effective use of silver dressings for the treatment of hard-to-heal chronic venous leg ulcers.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Health Sciences Faculty, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gregor B E
authors.initials: GB
authors.lastname: Jemec
authors.affiliation: Vertical, Paris, France.
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Kerihuel
authors.affiliation: School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Ousey
authors.affiliation: Coloplast A/S, Humlebaek, Denmark.
authors.forename: Sanne Lise
authors.initials: SL
authors.lastname: Lauemøller
authors.affiliation: School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.
authors.forename: David John
authors.initials: DJ
authors.lastname: Leaper
mesh_terms: D000328:Adult; D001458:Bandages / Q000191:economics*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D006801:Humans; D007871:Leg Ulcer / Q000188:drug therapy* / Q000191:economics*; D018803:Models, Economic; D016032:Randomized Controlled Trials as Topic; D012834:Silver / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000188:drug therapy* / Q000191:economics*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D012834:Silver