Dressings and Topical Agents for Chronic Wounds - NIHR Health ...

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ResultsTosti & Veronesi, 1983 132Comparison: Topical vs. Collagen dressingMean baseline area (cm 2 ): 19.7 19.6Sample size (N): 11 11No. of wounds healed (n/N): 1/11 (9%) 8/11 (73%) 26.6 (2.3, 308)Topical treatment: Daily antisepticWound type: Venous leg ulcerFollow-up time: 26 daysGreguric et al., 1994 133Comparison: Topical vs. Hydrocolloid(Varihesive E ® )Median baseline area (cm 2 ): Not stated Not statedSample size (N): 55 55No. of wounds healed (n/N): 0/55 (0%) 3/55 (5%) 7.4 (0.37, 146.8)Median absolute reduction inwound area/day (mm 2 ): 21 32Topical treatment: Magnesium sulphate pasteWound type: Venous leg ulcerFollow-up time: 10 dressing changesTeepe et al., 1993 131Comparison: Topical vs. Hydrocolloid (Granuflex)Baseline area (cm 2 ): Not stated Not statedSample size (N): 24 23No. of wounds healed (n/N): 6/24 (25%) 5/23 (22%) 0.83 (0.21, 3.2)Mean time to healing (days): 10 8.7 1.3Topical treatment: Cryopreserved cultured allograftsWound type: Venous leg ulcerFollow-up time: 6 weeksVarihesive E ® , Granuflex E, ConvaTec Ltd0.01 0.1 1 10 100 OR(95% CI)ES–4 –2 0 2 4 (95% CI)Favours topical agentFavours dressingFIGURE 22 Topical agents compared with dressings for venous leg ulcer36published trials. The overall funnel plot of allstudies that compared a traditional treatment witha modern therapy showed little evidence of asymmetry(Figure 23). However, for the subgroup oftrials that compared a hydrocolloid dressing witha traditional treatment asymmetry was clearlyevident (Figures 23 and 24). Publication bias forstudies favouring hydrocolloid treatment maybe responsible for this result.Cost-effectivenessThe unit cost of dressings and topical agents aremany times the cost of the traditional comparatorssuch as gauze. The newer agents, however, requireless-frequent dressing changes, for example everyfew days instead of twice daily, and hence requireless nursing time. In addition, the cost of treatinga wound for a long period with an inexpensivedressing may exceed that of treating the samewounds with a dressing that has a higher unit cost,but which is only required for a short period as aresult of its effectiveness. These arguments haveled to speculation that ‘modern’ dressings may bemore cost-effective than gauze-type comparators.Nine trials provided sufficient data on costs oftreatment to allow cost-effectiveness analysis(appendix 11).
Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 2)200Sample size1501005000.01 0.1 1 10 100ORFIGURE 23 A funnel plot for traditional treatments compared with modern dressings or topical agents for the treatment of legulcers and pressure sores.The plotted points indicate the ORs for wound healing for each trial included in the review. In the absence ofpublication bias the points should take the form of an upturned funnel; in the presence of publication bias, the points will be skewed inthe direction of the bias ( ,Traditional vs. dressing/topical agent other than hydrocolloid; , traditional vs. hydrocolloid dressing only)200Sample size95,96150561001015450999852,5355881005172 10200.01 0.1 1 10 100ORFIGURE 24 A funnel plot for traditional treatments compared with hydrocolloid dressings for the treatment of leg ulcers andpressure sores37
Page 1 and 2: Health Technology Assessment 1999;
Page 3 and 4: Systematic reviews of wound careman
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Page 10 and 11: Executive summarythan either an alg
Page 12 and 13: Introduction2sores) or due to under
Page 14 and 15: Introduction4healing rates are low
Page 22 and 23: ResultsMacfie & McMahon, 1980 34Com
Page 24 and 25: ResultsLe Vasseur & Helme, 1991 40C
Page 26 and 27: ResultsMustoe et al., 1994 43Compar
Page 28 and 29: ResultsSayag et al., 1996 49Compari
Page 30 and 31: ResultsOleske et al., 1986 57Compar
Page 32 and 33: ResultsBrod et al., 1990 66Comparis
Page 34 and 35: ResultsMoffatt et al., 1992 88Compa
Page 36 and 37: ResultsArnold et al., 1994 99Compar
Page 38 and 39: Results28healed under a lyophilised
Page 40 and 41: ResultsZuccarelli, 1993 113Comparis
Page 42 and 43: ResultsHolzinger et al., 1994 70Com
Page 44 and 45: ResultsWerner-Schlenzka & Kuhlmann,
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Health Technology Assessment panel
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HTA Commissioning BoardCurrent memb
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