Benefits and Cost-Effectiveness of Superabsorbent Dressings in the Treatment of Venous Leg Ulcers

Introduction

Hard-to-heal ulcers, defined as wounds open for more than 3 weeks, have a significant economic impact across the European Union. In Germany, more than 4 million chronic wounds are treated annually. The average expenditure on chronic ulcer therapy in this country is estimated at 9060 euros, including direct healthcare insurance costs (8288 euros) and patient out-of-pocket expenses (772 euros). Currently, there is little data providing highly accurate estimates of the costs of treating venous leg ulcers with moderate and high exudation.

For covering these wounds, current recommendations for first-line treatment include superabsorbent, alginate, foam dressings, hydro-polymer dressings, or dressings made of hydrofiber.

Superabsorbent dressings have a greater fluid retention capacity. They can also be used under compression, and some types of polyacrylate superabsorbent materials (SAPs) can reduce the activity of healing inhibitors, including metalloproteinases. Newer generations of these dressings include a silicone layer or silicone border, which reduces the risk of skin damage and minimizes pain during dressing changes.

However, there are currently no cost-effectiveness analyses for dressings recommended in first and second-line treatments. The cited analysis aimed to estimate the cost-effectiveness of treating patients with venous leg ulcers with moderate to high exudation using SAPs compared to the standard care, which includes other superabsorbent dressings and conventional dressings mentioned in therapeutic recommendations.

German Model and Analysis

The cost-effectiveness analysis was conducted using a model from the perspective of German statutory health insurance and based on German and international guidelines for good research practice. The authors used an individual (microsimulation) state-transition model with a cycle length of 1 week and a time horizon of 6 months. Several comprehensive systematic reviews were conducted to obtain all input information for the model, including clinical parameters, efficacy, quality of life, resource utilization, and cost data. Primary data were also used from 2 clinical studies.

Interventions evaluated in this study were 2 SAP dressings (Zetuvit Plus Silicone/Zetuvit Plus Silicone Border), using aggregated results. Standard dressings included other superabsorbent dressings (29%), antimicrobial (26%), foam (20%), alginate (5%), and other dressings (19%). This distribution aligns with therapeutic recommendations and reflects real-world practice for treating venous leg ulcers with moderate and high exudation.

The primary clinical outcome measured in this study was the proportion of healed ulcers. As a secondary outcome, health-related quality of life (HRQoL) was evaluated based on aggregated quality-adjusted life weeks (QALWs).

Results

As the model showed, 34.27% of patients with SAPs and 31.70% of patients with standard dressings achieve ulcer healing within 6 months. Thus, the 6-month use of SAPs compared to standard dressings in patients with venous leg ulcers with moderate to high exudation increases the proportion of healed ulcers by 2.57% (benefit ratio 1.08) and leads to a quality of life improvement of 0.152 QALW. All this at a reduction of direct treatment costs in Germany by 771 euros per patient.

Probabilistic sensitivity analysis showed that SAP is a type of dressing whose use is associated with treatment cost savings and offers greater clinical benefits in 100% of iterations.

French Model and Analysis

A very similar study was conducted with French data. Its aim was to compare the cost-effectiveness of superabsorbent dressings with foam dressings in the treatment of venous leg ulcers with moderate and high exudation under French pricing and reimbursement conditions according to Haute Autorité de Santé. A model was also created for this study, following French and international guidelines for good modeling practice. All inputs were data obtained from a systematic literature review.

Results

According to this model, the use of superabsorbent dressings for 6 months compared to standard dressings in patients with venous leg ulcers with moderate to high exudation leads to a higher proportion of ulcer healing by 2.58% and an improvement in HRQoL by 0.143 QALW. At the same time, this dressing was associated with treatment cost savings of 435 euros per patient over 6 months. These clinical results align with the therapeutic recommendation to use superabsorbent dressings as the first line of treatment for venous leg ulcers with moderate to high exudation.

Summary and Conclusion

According to the cost-effectiveness analysis conducted in Germany, the use of SAP dressings in patients with venous leg ulcers with moderate to high exudation is associated with an increased likelihood of ulcer healing, improved quality of life, and savings of 771 euros per patient over 6 months. In France, a similar model showed a higher proportion of healed ulcers and improved quality of life in treating venous leg ulcers with moderate to high exudation when applying superabsorbent dressings compared to foam dressings, with savings of 435 euros per patient over 6 months. As concluded by the authors of the analyses, these initial cost-effectiveness results need further verification.

(zza)

Sources:
1. Veličković V. M., Szilcz M., Milošević Z. et al. Cost-effectiveness analysis of superabsorbent wound dressings in patients with moderate-to-highly exuding leg ulcers in Germany. Int Wound J 2022 Feb; 19 (2): 447−459, doi: 10.1111/iwj.13645.  
2. Veličković V. M., Prieto P. A., Krga M., Jorge A. M. Superabsorbent wound dressings versus foams dressings for the management of moderate-to-highly exuding venous leg ulcers in French settings: an early stage model-based economic evaluation. J Tissue Viability 2022 Aug; 31 (3): 523−530, doi: 10.1016/j.jtv.2022.04.005.