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  

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Sideeffects

The most common side effect reported is 

pain.

71,73,77–86,88

 This may be due to agitation of 

larvae in the wound bed, or changes in the pH, but 

as yet is not fully understood.

Costeffectiveness

Larvae are expensive (UK 2011 price is £58 loose 

and £98.79 bagged, but prices vary between 

countries), but they are effective in rapid 

debridement of chronic wounds.

95

 Wayman

92

 

found that larvae were more cost effective than 

hydrogel (n=12) for treatment of leg ulcers, but 

the economic analysis was limited. Sherman

71

 

reports that larvae have traditionally only 

been used as a last resort and recommends that 

they should be used as a first or second line of 

treatment, to save costs. 

Larval therapy can quickly debride wounds 

requiring grafting and the separation of the necrotic 

tissue from live tissue allows for an easier surgical 

debridement.

71,78

 Gilead et al.

78

 argue that costs 

should be evaluated, not only by the cost unit of 

dressings, but also by costs associated to reduced 

length of stay in hospital, decreased amputation 

rates and reduced complications. However, in their 

RCT, Dumville et al.

83

 documented little difference 

in costs between hydrogel and larvae, indicating a 

cost of £96.70 on average more per participant with 

larvae compared with treatment with hydrogel, 

but patients’ quality of life showed an incremental 

cost effectiveness of approximately £8826 per QALY 

gained, £40 per ulcer-free day (QALY 0.011; 95%CI 

–0.067; 0.071).

 This was slightly better for the larvae 

group and healing was slightly faster, on average 

2.42 days faster than the hydrogel group.

82

conclusions 

There is a re-emergence in the use of larval therapy. 

Patient interest is growing due to the potential 

benefits and health professionals are becoming more 

familiar with this treatment method.

96

 The decision 

to use larval therapy is influenced by knowledge of 

their efficiency in debridement, disinfection and 

stimulation of healing in chronic wounds. Once 

staff are adequately informed, larval therapy can 

be performed easily and quickly, eradicating the 

discomfort of infection, malodour and necrosis, in 

a safe and cost-effective way.

92

 However, the choice 

for debridement by larvae therapy requires active 

participation, where possible, of the patient in the 

decisions about their own health care.

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