title: Estimating the Clinical Outcomes and Cost Differences Between Standard Care With and Without Cadexomer Iodine in the Management of Chronic Venous Leg Ulcers Using a Markov Model.
abstract: Chronic venous leg ulcers (VLUs) affect up to 1% of the adult population in the developed world and present a significant financial and resource burden to health care systems. Cadexomer iodine (CI) is an antimicrobial dressing indicated for use in chronic exuding wounds. The aim of this study was to estimate the cost utility of using CI + standard care (SC) - ie, high compression multicomponent bandaging including debridement - compared with SC alone in the management of chronic (>6 months' duration) VLUs from a payer's perspective. A Markov model was constructed to evaluate the cost and clinical benefits (healing and decreased infection rates) of the 2 treatment modalities over a 1-year period using data from 4 randomized, controlled clinical studies (RCTs) included in a recent Cochrane review and cost data from a recently published economic evaluation of VLUs. Costs were calculated using 2014 United States dollars; wound outcomes in- cluded complete healing in 212 patients reported in the Cochrane meta-analysis and quality-adjusted life years (QALYs), with utility values obtained from 200 patients with VLUs calculated using standard gamble. Treatment with CI over 1 year was $7,259 compared to $7,901 for SC. This resulted in a cost savings of $643/patient in favor of CI compared with SC. More patients treated with CI (61%) had their wounds healed compared to 54% treated with SC. Furthermore, patients treated with CI+SC experienced 6 additional ulcer-free weeks compared to persons treated with SC alone (ie, 25 ulcer- free weeks compared to 19 ulcer-free weeks, respectively). Overall, CI resulted in 0.03 more QALYs (ie, 0.86 QALYs compared to 0.83 for SC). The use of CI in addition to SC compared to SC alone over 52 weeks resulted in more wounds healed and more QALYs along with a decrease of overall costs The results of this study suggest CI is cost effective com- pared to SC alone in the management of patients with chronic VLUs. Prospective, controlled clinical studies are needed to elucidate the effect and cost effectiveness of CI on VLUs with and without signs of infection as compared to SC, other antiseptics, and more advanced topical treatment modalities.
authors.affiliation: Smith and Nephew Advanced Wound Management, Hull, UK.
authors.forename: Leo M
authors.initials: LM
authors.lastname: Nherera
authors.affiliation: Smith and Nephew Advanced Wound Management, Hull, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Woodmansey
authors.affiliation: Smith and Nephew Advanced Wound Management, Hull, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Trueman
authors.affiliation: South Shore Hospital Center for Wound Healing, Weymouth, MA.
authors.forename: Garry W
authors.initials: GW
authors.lastname: Gibbons
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000592:standards*; D003661:Decision Support Techniques; D006801:Humans; D007466:Iodophors / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D007871:Leg Ulcer / Q000188:drug therapy / Q000503:physiopathology; D009779:Occlusive Dressings / Q000592:standards; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D007466:Iodophors; C038634:cadexomer iodine