Cost-effectiveness of an enhanced silver-containing dressing in treating hard-to-heal venous leg ulcers

To estimate the cost-effectiveness of using a carboxymethylcellulose dressing containing ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride (CISEB; Aquacel Ag+ Extra, Convatec Ltd., UK) compared with a dialkylcarbamoyl chloride-coated dressing (DACC; Cutimed Sorbact, Essity, Germany) in the treatment of hard-to-heal venous leg ulcers (VLUs), from the perspective of the UK's publicly-funded health services.

Markov modelling simulated the management of hard-to-heal VLUs in the community and secondary care over 24 weeks. The modelling used data from a randomised controlled trial and estimated the relative cost-effectiveness of the two dressings, measured by the incremental cost per quality-adjusted life year (QALY) gained, based on 2022/23 prices.

The findings of the modelling showed that starting treatment with CISEB instead of DACC resulted in a >25% increase in the probability of healing. However, the time to healing was similar in both groups, averaging at seven weeks per ulcer. The difference in the probability of healing between the two groups led to a cumulative gain in QALYs, resulting in a 5% improvement in health-related quality of life at 24 weeks. The higher healing rate in the CISEB group led to a ~14% reduction in the total cost of VLU management over 12 weeks and a 23% reduction over 24 weeks. Consequently, starting treatment with CISEB instead of DACC was identified as a potentially cost-effective intervention for treating hard-to-heal VLUs within the UK's health services, as it improved outcomes at a lower cost.

Considering the study's limitations, treating hard-to-heal VLUs with CISEB instead of DACC potentially offers a cost-effective strategy for the UK's health services, since it increases the likelihood of VLU healing for lower cost.