Carboxymethyl Cellulose, Trichloroacetic Acid, and Unna Boot for Healing Venous Ulcers: A Comparative Study of Their Efficacy and Socioeconomic Impact.

Chronic ulcers are defined as a breakdown of the long-term cutaneous barrier or frequent recurrence of breakdowns. Dressings are a form of treatment and, in view of the variety and high cost of the products on the market, three agents were selected for this investigation, regarding their efficacy and cost/benefit ratio. The objective of the investigation was to evaluate and compare the efficacy, costs, and benefits of carboxymethylcellulose in paste at 20% (CMC 20%), trichloroacetic acid at 90% (TCA 90%), and Unna boot for treatment of chronic venous ulcers. Three groups of 30 patients each were chosen randomly for ambulatory treatment with TCA 90% (G1), CMC 20% (G2), and Unna boot (G3). The evolution of the cicatricial process of each group separately and between groups was analyzed with measurement of the lesion areas in square centimeters (cm2) and observation of the amount of exudate from observation of the photographic record, until their healing, in the maximum period of 20 weeks. A significant reduction of lesion areas in all groups was observed (P=.0001), with a median reduction of 7.6 cm2 (38.1%) for G1, 3.9 cm2 (38.8%) for G2, and 16.2 cm2 (77.8%) for G3. There was a significant difference in the absolute delta of the lesion areas (P=.0001) of the groups. The three types of treatments promoted effective improvement, with acquisition and utilization of all three products in the public health services being recommended.

Custo do tratamento de úlceras venosas no ambulatório e domicílio: estudo descritivo / Cost of the treatment for venous ulcers in an outpatient clinic and in the household: a descriptive study / Costo del tratamiento de úlceras venosas en el ambulatorio y en el domicilio: estudio descriptivo

OBJETIVO: Comparar os custos diretos do tratamento de úlceras venosas com gel de carboximetilcelulose nos ambientes domiciliar e ambulatorial. MÉTODO: Estudo descritivo, com realização de 96 consultas no Ambulatório de Reparo de Feridas de um hospital universitário, entre abril e dezembro de 2013. Foram identificadas categorias de custo, definidos valores monetários e realizados cálculos baseados no consumo dos materiais no ambulatório e dispensados para o domicílio. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do hospital sob o número 196/08. RESULTADOS: Após 84 dias de seguimento, os custos do tratamento ambulatorial foram maiores do que os custos do tratamento domiciliar, e a principal responsável por essa diferença é a mão de obra do enfermeiro. CONCLUSÃO: É necessário definir estratégias para a realização de consultas de enfermagem efetivas com orientações para o tratamento domiciliar e dispensação do material para o paciente.

AIM: To compare the direct costs of treatment of venous ulcers involving the use of carboxymethylcellulose gel in domiciliary and outpatient environments. METHOD: This is a descriptive study, in which 96 consultations were performed in the Wound Healing Clinic of a university hospital between April and December 2013. Cost categories were identified, monetary values were defined and calculations were based on the consumption of materials used in the clinic and later released to the patients' homes. The study was approved by the Research Ethics Committee of the hospital under the number 196/08. RESULTS: After 84 days of follow-up, outpatient treatment costs were higher than the home care costs, and the main reason for this difference was nursing manpower. CONCLUSION: It is necessary to define strategies for conducting effective nursing consultations and these strategies should include guidelines for home care and the dispensing of the material for patients.

OBJETIVO: Comparar los gastos directos del tratamiento de úlceras venosas con gel de Carboximetilcelulosa en los ambientes domiciliario y ambulatorio. MÉTODO: Estudio descriptivo, con realización de 96 consultas en el Ambulatorio de Reparación de heridas de un hospital universitario, entre abril y diciembre de 2013. Fueron identificadas categorías de costo, definidos valores monetarios y realizados cálculos basados en el consumo de los materiales en el ambulatorio y dispensados para el domicilio. El estudio fue aprobado por el Comité de Ética en Pesquisa del hospital con el número 196/08. RESULTADOS: Después de 84 días de seguimiento, los gastos del tratamiento ambulatorio fueron mayores de que los gastos del tratamiento domiciliario, y la principal responsable por esa diferencia es la mano de obra del enfermero. CONCLUSIÓN: Es necesario definir estrategias para realizar consultas de enfermería efectivas con orientaciones para el tratamiento domiciliario y la dispensación del material para el paciente.

Clinical evaluation comparing the efficacy of aquacel Ag with vaseline gauze versus 1% silver sulfadiazine cream in toxic epidermal necrolysis.

OBJECTIVE: The purpose of this study was to determine whether using Aquacel Ag (ConvaTec, Skillman, New Jersey) with Vaseline (Unilever, London, England) gauze instead of silver sulfadiazine cream (SSD) as the wound care protocol to treat toxic epidermal necrolysis (TEN) can improve wound healing, pain control, and reduction of labor costs. DESIGN: A retrospective chart review. SETTING: A burn center with 2 plastic surgeons and 11 nursing staff. PATIENTS: A pathologist diagnosed TEN in 35 patients admitted to the burn center from 1995 to 2009. MAIN OUTCOME MEASURES: Parameters included the patient's profile, dressing choice, severity-of-illness score for TEN, time to 95% re-epithelialization, visual analog scale pain scores before second dressing change, and labor cost. The exclusion criterion was wound care with neither Aquacel Ag with Vaseline nor SSD exclusively. RESULTS: Twenty patients were enrolled in this study. In the group using Aquacel Ag with Vaseline gauze, the visual analog scale score was significantly less than that of the SSD group (P = .02). Labor costs were significantly lower in the Aquacel Ag with Vaseline gauze group (P < .01). Commencement of specific dressing to 95% re-epithelialization (P = .09) and time spent in the second dressing change (P = .05) had no statistical significance between the 2 groups. CONCLUSIONS: This study showed that Aquacel Ag with Vaseline gauze decreased pain and labor costs but did not shorten wound healing time. Thus, Aquacel Ag with Vaseline gauze can be an efficient method for treating TEN wounds.

Avaliação do custo de colírios lubrificantes a base exclusivamente de carboximetilcelulose no mercado brasileiro / Evaluation of the cost of lubricating eye drops based exclusively on carboxymethylcellulose in the brazilian market

OBJETIVO: Avaliar o custo do uso dos colírios lubrificantes mais utilizados no mercado nacional que apresentam na formulação o mesmo princípio ativo - carboximetilcelulose, considerando o número total de gotas presente em cada frasco dos colírios. MÉTODOS: Foi realizado um estudo experimental utilizando três frascos de cada um dos colírios Lacrifilm® (colírio 1) e Fresh Tears® (colírio 2). Para análise do custo dos colírios contou-se o número de gotas de cada frasco correlacionando os preços dos mesmos. O preço considerado para cada medicação foi o mínimo ao consumidor com alíquota de 17% publicado para o mês de janeiro de 2012. A análise estatística foi efetuada em SPSS® 18. A comparação das variáveis quantitativas analisadas foi procedida através do teste não paramétrico Mann-Whitney e correlação linear de Spearman, sendo considerada uma diferença estatisticamente significante um valor de probabilidade inferior a 0,05. RESULTADOS: Verificou-se que há diferença estatisticamente significativa entre as marcas de colírios avaliados com relação ao número total de gotas. O colírio 1 apresentou o maior número de gotas. CONCLUSÃO: O colírio 1, que tem o maior número de gotas por frasco, também é o que tem o preço mais acessível. Portanto, verifica-se que é o produto mais econômico, ou seja, o paciente pagará menos por cada gota.

OBJECTIVE: The objective of this study is to evaluate the cost of the use of lubricant eye drops, which are more used in the national market and contain in its formulation the same active ingredient - carboximeticelulose -, by considering their total number of drops in each flask. METHODS: An experimental study was accomplished by using three flasks of each one of the following eye drops: Lacrifilm®(eye drop 1) and Fresh Tears®(eye drop 2). To the analysis of their cost, the number of drops of each flask was counted, correlating them with their price. The price considered for each medication was the minimum to consumer with an aliquot of 17% published for the month of January 2012. The statistical analysis was accomplished in SPSS®18. The comparison of the quantitative variables evaluated was followed through the non-parametric test Mann-Whitney and Spearman linear correlation, in which a significant statistical difference was considered, a value of probability inferior to 0,05. RESULTS: It was verified statistically significant difference between brands of eye drops evaluated in relation to their total number of drops per flask as well as to their prices. Eye drop 1 presented greater number of drops. CONCLUSION: Eye drop 1, which has the greater number of drops per flask, also has the lowest price. Therefore, it is verified that the product is the most economical, what means that the patient will pay less for each drop.

Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs.

OBJECTIVE: To estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose dressing (CMC [Aquacel]) and four super absorbent dressings (DryMax Extra[DM], Flivasorb [F], Kerramax [K] and sachet S [S]) in the treatment of highly exuding chronic venous leg ulcers (VLUs) in the UK, from the perspective of the National Health Service (NHS). METHOD: A decision model was constructed depicting the patient pathways and associated management of a cohort of 439 patients with highly exuding chronic VLUs of;;: 3 months of age. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN)database (a nationally representative database of patients registered with general practitioners (GPs) in the UK) who were treated with one of the five dressings. The model estimated the costs and outcomes of patient management over 6 months and the relative cost-effectiveness of using each dressing. RESULTS: Patients' mean age was 73.1 years, and 46% were female. Between 39% and 56% ofVLUs healed by 6 months. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis. The 6-monthly NHS cost of managing a VLU with S was £3700 per patient, which was 15-28% lower than the cost of managing patients with the other three super absorbents. Additionally, use of S improved patients' health status to a greater extent than the other three super absorbents, since S-treated patients accrued 0.3-3% more QALYs. Starting treatment with S was the preferred strategy followed by DM, K and Fin that order. CONCLUSION: Within the limitations of the data set,S affords the NHS a cost-effective treatment for managing highly exuding chronic VLUs of ≥3 months of age, compared with DM, F, K and CMC.

A randomized comparison study of Aquacel Ag and Glucan II as donor site dressings with regard to healing time, cosmesis, infection rate, and patient's perceived pain: a pilot study.

This study was undertaken to compare pain, healing time, infection rate, and cosmetic outcome between Aquacel Ag (Convatec) and Glucan II (Brennan Medical) as donor site dressings. The authors performed a prospective, randomized, patient-controlled study. Eligible patients had two donor sites harvested. One site was dressed with Aquacel Ag and the other site with Glucan II. Patients were followed at set time points for 6 months to determine the rate of epithelialization, patient's perceived pain, infection rate, and the cosmetic outcome. A total of 20 patients were enrolled in the study. All patient data were collected through reepithelialization. The average time to wound healing for Aquacel Ag was 12.5 ± 2.07 days compared with Glucan II 12.7 ± 1.99 days. Perceived pain scores for each donor site were recorded. On postoperative day 5, patients reported significantly less pain with the Aquacel Ag site (Aquacel Ag 1.75 vs Glucan II 2.5, P = .02). Three donor sites showed clinical signs of infection (two Glucan II and one Aquacel Ag) prompting culture and dressing removal. There was no statistically significant difference in cosmetic outcomes of the donor sites at any time point. When comparing Aquacel Ag and Glucan II, our study has determined that there is no significant difference with regard to healing time, infection rates, and cosmetic outcomes. Both dressings are comparable with regard to ease of application and postoperative care.

A prospective, randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns.

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008. Patients were divided into two groups: Aquacel Ag-treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine-treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups. Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group (10 +/- 3 versus 13.7 +/- 4 days, P < 0.02) as well as pain scores at days 1, 3 and 7 (4.1 +/- 2.1, 2.1 +/- 1.8, 0.9 +/- 1.4 versus 6.1 +/- 2.3, 5.2 +/- 2.1, 3.3 +/- 1.9, respectively, P < 0.02). Total cost of treatment was 52 +/- 29 US dollars for the Aquacel Ag-treated group versus 93 +/- 36 US dollars for the silver sulfadiazine-treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.

Moist wound healing compared with standard care of treatment of primary closed vascular surgical wounds: a prospective randomized controlled study.

This study was a randomized-controlled trial comparing the standard type of dry dressing, Mepore, with moist wound healing, using a hydrofiber dressing, Aquacel, in primary closed wounds after vascular surgery. The endpoints were patient comfort, cost-effectiveness, infections, wound complications, and length of hospital stay. One hundred and sixty patients were randomized to receive either Mepore or Aquacel dressing. There was no significant difference in patient comfort between the two groups, but a higher cost in the Aquacel group despite significantly fewer changes of dressings in these patients. No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover, the traditional dressing scheme was significantly less expensive.

A silver-impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients.

PURPOSE: Since using a novel silver-impregnated antimicrobial dressing (Aquacel Ag, ConvaTec, Princeton, NJ) in our pediatric patients with partial-thickness burns, hospital LOS has been significantly reduced. Here we investigated whether there was concomitant cost-effectiveness of this approach. METHODS: We retrospectively reviewed Burn Registry Data from a large Children's Hospital Burn Unit from January 2005 through August 2005 for inpatients with partial-thickness burns treated with Aquacel Ag. A comparison group was composed of patients from the same period the previous year treated with silver sulfadiazine cream (SSD, Par Pharmaceuticals, Woodcliff, NJ) and matched for age and %TBSA burned. Patients with inhalation injury or full-thickness burns were excluded. Intent-to-treat analysis was limited to patients with less than 22% TBSA burn. Direct costs and total charges were compared statistically after log transformation due to the skewedness of the data. RESULTS: Total charges and direct costs were significantly lower for Aquacel Ag-treated patients (n = 38) than for SSD-treated patients (n = 39) (P = .004 and P < .001, respectively). In addition, Aquacel Ag-treated patients had a shorter LOS than SSD-treated patients. DISCUSSION: These data strongly support our findings that the application of Aquacel Ag reduces hospital LOS which results in a significant cost savings in the care of pediatric patients with partial-thickness burns.

Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.

This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.

Cost effectiveness of using carboxymethylcellulose dressing compared with gauze in the management of exuding venous leg ulcers in Germany and the USA.

OBJECTIVE: To assess the cost effectiveness of using carboxymethylcellulose dressing (CMCD; Aquacel Hydrofiber) compared to gauze in the management of exuding venous leg ulcers in Germany and the USA. DESIGN AND SETTING: This was a modelling study performed from the perspective of payers (i.e. the sickness funds in Germany and the community sector in the USA). METHODS: Clinical outcomes attributable to managing exuding venous leg ulcers were obtained from the published literature in the English language. These data were combined with resource utilisation estimates derived from a panel of clinicians enabling us to construct two decision models depicting the management of venous leg ulcers with CMCD or gauze over 18 weeks in Germany and the USA. The models were used to estimate the cost effectiveness of CMCD compared to gauze in the management of exuding venous leg ulcers in both countries. MAIN OUTCOME MEASURES AND RESULTS: Starting treatment with CMCD instead of gauze in both Germany and the USA is expected to heal 30% of ulcers within 18 weeks compared to 13% with gauze (p = 0.003). The healthcare cost of starting treatment with CMCD or gauze in Germany is expected to be Euro2020 and Euro 2654 respectively at 18 weeks. Additionally, the healthcare cost of starting treatment with CMCD or gauze in the USA is expected to be $3797 and $5288 respectively at 18 weeks. Hence, using CMCD instead of gauze is expected to increase the probability of healing within 18 weeks by 130% and reduce healthcare costs by at least 24%. The healthcare cost of managing CMCD-treated patients was less than that of gauze-treated patients in both countries due to decreased nursing and physician costs associated with a lower frequency of CMCD dressing changes compared to gauze dressing changes. If it were assumed that treatment with gauze in both countries heals 30% of ulcers within 18 weeks (i.e. is identical to CMCD), then the expected healthcare cost of using gauze would be reduced by only 3% (from Euro2654 to Euro2562 in Germany and from $5288 to $5148 in the USA). CONCLUSION: Within the limitations of our model, starting management of an exuding venous leg ulcer with CMCD instead of gauze is the cost effective strategy in both Germany and the USA. Moreover, the purchase price of a leg ulcer dressing should not be used as an indication of the cost effectiveness of a given method of care.

Modelling the cost implications of using carboxymethylcellulose dressing compared with gauze in the management of surgical wounds healing by secondary intention in the US and UK.

OBJECTIVE: To estimate the costs of using carboxymethyl cellulose dressing (CMCD; Aquacel* Hydrofiber) compared to gauze in managing surgical wounds healing by secondary intention in the US and UK. STUDY DESIGN: This was a modelling study performed from the perspective of payers (i.e. the hospital and community sector in the US and the National Health Service (NHS) in the UK). METHODS: Clinical outcomes attributable to managing surgical wounds healing by secondary intention with gauze were obtained from the published literature in the English language. There were no published studies on wounds healing by secondary intention with CMCD. Hence, the analysis conservatively assumed that wound healing rates associated with gauze would be the same for CMCD. These data were combined with resource utilisation estimates derived from a panel of clinicians enabling us to perform decision modelling. The models were used to determine the expected direct healthcare costs eight weeks after the surgical wounds were dressed by CMCD or gauze and left to heal by secondary intention in the US and UK. RESULTS: All wounds are expected to heal within eight weeks, irrespective of dressing. Managing abscesses and other surgical wounds with CMCD instead of gauze in the US is expected to reduce costs by 4% in both wound types (i.e. $247 and $507 respectively) per patient over eight weeks. In the UK, managing abscesses and other surgical wounds with CMCD instead of gauze is expected to reduce costs by 30% (574 pounds) and 12% (581 pounds) respectively per patient over eight weeks. The lower cost of managing CMCD-treated patients is due to decreased nursing costs associated with a lower frequency of CMCD changes compared to gauze dressing changes. CONCLUSION: Dressing surgical wounds healing by secondary intention with CMCD instead of gauze is expected to lead to a reduction in healthcare costs in both the US and UK. Hence, the purchase price of a dressing is not indicative of the cost effectiveness of a given method of surgical wound care.

Why gauze dressings should not be the first choice to manage most acute surgical cavity wounds.

Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.