Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3

Author(s) & date of publication type and results

Wayman (2000)

92

Astudyincluding12 patientswithvenouslegulcerationanddeemedtorequiredebridement.

Treatmentwithlarvaltherapywascomparedwithhydrogeldressingtreatment.Effective

debridementoccurredwithamaximumofonelarvalapplicationinallsixpatientsinthat

group.Conversely,twopatients(33%)inthehydrogelgroupstillrequireddressingsat1 month.

Themediancostoftreatmentofthelarvalgroupwas£78.64comparedwith£136.23forthe

controltreatmentgroup(hydrogels;p≤0.05).

Soares (2009)

93

Costeffectivenessandcostutilitywasanalysedextensively,alongsidea12-monthRCTcomparing

larvaltherapywithhydrogels,inthedebridementoflegulcers.Treatmentwithlarvaltherapy

cost,onaverage,£96.70(GBP)moreperparticipantperyearcomparedwithtreatmentwith

hydrogels.Healingtimewasonaverage2.4 daysshorterwithlarvaltherapy(p=n/s)andaslightly

betterhealth-relatedqualityoflifewasseen.Itwasconcludedthatthetreatmentstrategieswere

likelytoproducesimilarhealthbenefitsandcost;howevertherewasconsiderableuncertainty

regardingoutcomeestimatesinthestudy,especiallyduetodropoutrateandcomorbidities.This

ambitiousstudyillustratesthecomplexityandchallengeofperformingthesekindsofstudies.

caputo et al. (2008)

99

Inacomparativestudyhydrosurgery(Versajet;Smith&Nephew)wascomparedwith

conventionalsurgicaldebridementinlowerextremityulcers.Proceduraltimeandutilisation

ofconsumableswererecorded.Itwasconcludedthathydrosurgeryresultedinashorter

debridementtime,withareductioninuseofpulsedlavageandsalineindicatingpotentialcost

savings.Howevertherewasnodifferencewithregardtomediantimetohealingorhealing

ratecomparingthetwostrategies.

lewis et al. (2001)

134

Inasystematicreviewofclinicalandcosteffectivenessofdebridingagentsintreatingsurgical

woundsbysecondaryintention,itwasconcludedthatnoevaluationscomparedthecost

effectivenessoftwodifferenttypesofmoderndressings.Allfourstudiesincludedinthe

evaluationcomparedanautolyticdebridementmethodwithtraditionalgauzedressingssoaked

invariousantisepticsolutions.Moststudiesincludedsuggestedpositiveeffectswithregardto

clinicalandcosteffectiveness;however,thesestudiesdidnotsupportthesuperiorityofone

dressingoveranother.

Graninck et al. (2006)

153

Hydrosurgerywasfoundtoreducethenumberofsurgicalproceduresrequiredtoachieveaclean

woundbed,inarangeofacuteandchronicwounds(mean1.2vs1.9proceduresperpatient,for

hydrosurgeryandconventionaldebridement,respectively).Inthestudythereductionofnumber

ofprocedureswasestimatedtoanoverallsavinginthecostofdebridementof$1900(USD).

Mosti (2006)

154

Thisretrospectiveevaluationclaimsthathydrosurgeryresultsinreductionofinhospitalstay

relatedtothedebridementofhard-to-heallegulcers.

Mulder (1995)

155

Inaverysmallretrospectiveanalysisofgelversuswet-to-dry(moistenedsalinegauze)for

debridementofdryeschar,itwasshownthatthedailycostwashigherwiththehydrogel/

polyurethanemethod,butmorecosteffectivetakingaccountoftimerequiredtoachieve≥50%

debridementalongwithtimetochangedressingsandamountofmaterialneeded.