Department of Dermatology, Health Sciences Faculty, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark.
Vertical, Paris, France.
PLoS One. 2014 Jun 19;9(6):e100582. doi: 10.1371/journal.pone.0100582. eCollection 2014.
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).
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.
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.
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.
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.
基于愈合时间，使用基于健康经济学模型评估银敷料在治疗难以愈合的慢性静脉性腿部溃疡（VLU）中的成本效益。
慢性静脉溃疡影响 1-3%的成年人口，通常具有漫长的愈合过程，给医疗保健系统带来了相当大的成本。VLU 的发病机制包括过度和延长的炎症，这通常与严重定植和早期感染有关。使用银敷料来控制这种生物负荷并提高愈合率仍然存在争议。
构建决策树来评估在初级保健环境中使用银敷料与非银敷料治疗四周的成本效益。结果为“愈合溃疡”、“愈合溃疡”或“无改善”，反映了从基线到治疗四周溃疡面积的相对减少。应用最近四项 RCT 的荟萃分析数据集来对模型进行评估。
与非银敷料治疗相比，最初四周使用银敷料治疗可节省总费用（141.57 英镑）。此外，与使用非银敷料治疗的患者相比，使用银敷料治疗的患者伤口愈合更快。
使用银敷料可缩短愈合时间并节省总体成本。这些结果可用于指导医疗保健决策者评估在难以愈合的慢性 VLU 中使用银敷料治疗的经济方面。
