Cath Lab Digest

A Prospective, Randomized Clinical Trial to Assess the Cost-effectiveness of a Modern Foam Dressing versus a Traditional Saline Gauze Dressing in the Treatment of Stage II Pressure Ulcers

Abstract Modern dressings such as hydrocolloids, gels, and foams are typically more expensive than traditional dressings such as gauze. However, if modern dressings require fewer changes, the overall cost of treatment may be lower despite the higher initial purchase price. If healing rates are comparable or better, modern dressings also may be cost-effective. A 4-week, prospective, randomized clinical trial to assess differences in treatment costs and cost-effectiveness between a modern foam dressing and saline-soaked gauze was conducted among 36 patients (22 men, 14 women, mean age 72.8 years) with a Stage II pressure ulcer (mean duration 35 weeks) at five centers in the United States. Participants were randomized to treatment with a self-adhesive polyurethane foam (n = 20) or saline-soaked gauze dressing (n = 16). No difference in time to wound closure was observed (P = 0.817). Patients in the foam group had less frequent dressing changes (P <0.001). Total cost over the study period was lower by $466 per patient (P = 0.055) and spending on dressings was lower by $92 per patient in the foam group (P = 0.025). Cost per ulcer healed was lower by $1,517 and cost per ulcer-free day was lower by $80 for patients in the foam group. On the evidence of this study, the foam dressing is a more cost-effective treatment than saline-soaked gauze for the treatment of Stage II pressure ulcers.

     Two studies^1,2 published in the 1960s demonstrated that a moist wound environment is associated with quicker healing than an environment where a wound is allowed to dry through exposure to the air. In principle, traditional dressings such as gauze can provide an appropriate wound environment providing they are kept moist, usually by adding saline. To keep the wound from drying out, saline-soaked gauze normally is changed at least daily. Modern dressings such as hydrocolloids, foams, and hydrogels have been designed to provide improved moisture handling properties that make it possible to maintain a moist wound environment without the need for daily dressing changes.

     The evidence base in wound care generally is poor. Several recent reviews^3-5 have highlighted the fact that there is little compelling evidence of a significant difference in time to healing or percent healed when comparing patients treated with traditional versus modern dressings. The per-unit price of modern dressings tends to be higher, which may explain why traditional products are still commonly used in routine clinical practice.

     However, healing is not the only relevant end point in a comparison between treatments that differ not only in the type of dressing used, but also in the frequency of dressing changes. Frequency of dressing change has a direct impact on the amount of nurse time required for a given treatment period and on the quantities and cost of dressings and other materials. Even in the absence of evidence of a difference in time to healing, costs per patient may be lower using a more expensive dressing if the frequency of dressing change is lower.