Antimicrobial silver dressings beneath compression for venous ulceration are not cost-effective compared with standard dressings.

摘要

Wound-bed preparation is considered the gold standard for chronic non-healing wounds, particularly venous leg ulcers. Several systematic reviews and meta-analyses have studied silver dressings as innovative treatment products designed to control and inhibit infection and provide an environment conducive to wound healing. At the same time, cost savings and improved effectiveness are concerns in clinical wound treatment. There is little literature on the cost-effectiveness of silver dressings versus other approaches to treating lower leg venous ulcers.Michaels and colleagues set out to determine whether there is any significant reduction in treatment costs or increase in wound healing rate among patients with lower leg venous ulcers when silver-based dressings rather than non-silver dressings are used. The study design was a multicentre randomised (stratification according to ulcer size and treatment centre) controlled study with concealed allocation lasting 12 weeks in two geographical areas in South Yorkshire and Devon, UK. The sample was 213 patients (experimental group: mean age 68.8 years; control group: mean age 72.4 years) who had had active venous leg ulceration for longer than 6 weeks. Exclusion criteria included insulin-controlled diabetes mellitus, pregnancy, sensitivity to the use of silver, ankle bra-chial pressure index <0.8, ulcer area <1 cm, vasculitis, and oral or parenteral antibiotic treatment. Patients were treated with either silver-donating dressing (Urgotul SSD, Aquacel Ag, n=107) or non-silver, low-adherence dressing (Urgotul, Biatain, Atrauman, Allevyn, n=106).