Massand S, Lewcun JA, LaRosa CA, et al.
Journal of wound care. Date of publication 2021 Jul 2;volume 30(7):553-561.
1. J Wound Care. 2021 Jul 2;30(7):553-561. doi: 10.12968/jowc.2021.30.7.553.
Clinical and cost efficacy of advanced wound care matrices in the treatment of
venous leg ulcers: a systematic review.
Massand S(1), Lewcun JA(2), LaRosa CA(3).
Author information:
(1)Penn State Hershey College of Medicine and Milton S. Hershey Medical Center,
PA, US.
(2)Virginia Commonwealth University, Richmond, VA, US.
(3)Good Samaritan Hospital Medical Center, Bay Shore, NY, US.
BACKGROUND: Venous leg ulcers (VLUs) are hard-to-heal, recurrent and challenging
to treat. Advanced wound care matrices (AWCMs) have been developed to supplement
conventional therapies. These costly AWCMs warrant careful comparison as
healthcare expenditures are subjected to increasing scrutiny.
AIM: This study was designed to compare AWCMs in their ability to heal VLUs and
their cost efficacy through a systematic review of randomised controlled trials
(RCTs).
METHOD: An organised search of Medline, Cochrane Library, Central and CINAHL
databases identified RCTs that compared AWCMs to standard compression therapy in
the healing of VLUs. Bias was assessed using the Effective Public Health
Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Eight
studies analysing bilayered skin substitute (BSS) (Apligraf), dehydrated human
amnion/chorion membrane (dHACM) (Epifix), human fibroblast-derived dermal
substitute (HFDDS) (Dermagraft), extracellular wound matrix (ECM) (Oasis),
advanced matrix (AM) (Talymed) and matrix wound dressing (MWD) (Promogran) met
the inclusion criteria.
RESULTS: Four studies reported significant improvement over standard therapy:
BSS, dHACM, ECM and AM. Incremental cost per additional successful treatment was
determined for each trial, ranging from $2593 (MWD) to $210,800 (HFDDS).
CONCLUSION: Our consolidated analysis of eight major RCTs of AWCMs in the
treatment of VLUs revealed a great variation in clinical and cost efficacy among
these products. The included trials were inconsistent in methodology, and these
limitations should be noted, but, in the absence of RCTs to compare these
products, our systematic review may serve as a guide for practitioners who seek
to optimise wound healing while considering cost efficacy.
DOI: 10.12968/jowc.2021.30.7.553
PMID: 34256600 [Indexed for MEDLINE]
