Table 1.
Summary of characteristics of included studies
| Study | EE type | Intervention | Comparator | Country, perspective | Currency, price year | Model type (cycle length, time horizon) | Model states/tree summary | Outcome measures | Sensitivity analysis | Result |
|---|---|---|---|---|---|---|---|---|---|---|
| Markov models | ||||||||||
| Carr et al. 1999 [35] | CEA | Four-layer bandaging system (Profore) | Charing Cross System of four-layer bandaging | UK, not stated | GBP (£) 1997/98 | Markov model (1 week, 1 year) | Healed and unhealed | Median time to heal | Univariate deterministic | Intervention dominant |
| Schonfeld et al. 2000 [42] | CEA | Skin substitute (Apligraf) | Zinc-impregnated gauze (Unna’s boot) | USA, commercial health plan | USD ($) 1996 | Markov model (1 month, 1 year) | Unhealed, healed, recurrence, no therapy | Number of months during the year in a healed ulcer state, % of patients with healed ulcers | Univariate deterministic | Intervention dominant |
| Scanlon et al. 2005 [29] | CEA | Silver-releasing dressing (Contreet Foam) | Aquacel Ag, Actisorb Plus, Iodoflex | UK, societal | GBP (£) 2003/04 | Markov model (1 week, 26 weeks) | Healed, non-healed | Percentage reduction in wound area, number of healed wounds | Univariate deterministic | Intervention dominant |
| Iglesias and Claxton 2006 [46] | CEA + CUA | Oral pentoxifylline | Placebo with standard care (compression therapy and wound dressings) | UK, NHS | GBP (£) 2004 | Markov model (1 week, 1 year) | Healed, unhealed, death | Ulcer-free weeks, QALYs | Univariate deterministic | Intervention dominant |
| Clegg and Guest 2007 [44] | CEA + CUA | Bio-electric stimulation therapy (Posifect) | Standard care (compression therapy and wound dressings) | UK, NHS | GBP (£) 2005/06 | Markov model (1 week, 16 weeks) | Healed, improved, unchanged, worsened, dead | % of healed patients at 16 weeks, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Guest et al. 2009 [39] | CEA + CUA | Amelogenin | Standard care (compression therapy and wound dressings) | UK, NHS | GBP (£) 2006/07 | Markov model (1 month, 1 year) | Unchanged worsened, improved, healed, recurrence, dead | % of healed patients, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Taylor et al. 2011 [43] | CEA + CUA | Electric stimulation (Accel-Heal) | Standard care (compression therapy and wound dressings) | UK, NHS | GBP (£) 2008/09 | Markov model (1 month, 5 months) | Unchanged, worsened, improved, healed, recurrence | Probability of healing, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Carter et al. 2014 [41] | CEA | Extracellular matrix (OASIS) | Human skin equivalent, living skin equivalent, standard care (compression therapy and wound dressings) | USA, payer | USD ($) 2012 | Markov model (1 week, 1 year) | Unhealed, healed, death | Healed wound weeks, expected wound closure rate | Univariate deterministic, probabilistic | Intervention dominant |
| Ashby et al. 2014 [38] | CUA | Two-layer bandage | Two-layer hosiery, four-layer bandage, short-stretch bandage, paste bandage | UK, NHS | GBP (£) 2011 | Markov model (1 month, 12 years) | Unhealed, healed, death | QALYs | Probabilistic | Intervention dominant |
| Kaspar et al. 2015 [28] | CEA | Polyacrylate-based hydrogel (HydroClean) | Amorphous hydrogel | Germany, payer | Euro (€) not stated | Markov model (1 day, 14 days) | Wound bed covered with ≤ 50% granulation tissue, wound bed covered with > 50% granulation tissue | Mean days with > 50% granulation tissue | None | Intervention dominant |
| Nherera et al. 2016 [34] | CEA + CUA | Iodine dressing (Cadexomer iodine) | Standard care (compression bandaging with debridement) | USA, payer | USD ($) 2014 | Markov model (1 week, 1 year) | Healed, unhealed, infected, dead | Ulcer-free weeks, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Walzer et al. 2018 [24] | CEA + CUA | Hydration response technology dressing (Cutimed Sorbion Sachet S) | Four superabsorbent dressings (Zetuvit Plus, KerraMax Care, Eclypse, DryMax extra) | UK, NHS | GBP (£) not stated | Markov model (1 week, 1 year) | Healed, improving, unchanged, deteriorating, infected or complications | Time taken to heal wound, QALYs | Univariate deterministic | Intervention dominant |
| Decision tree models | ||||||||||
| Guest et al. 2005 [30] | CEA | Carboxymethylcellulose dressing (Aquacel hydrofiber) | Gauze dressing | Germany and USA, payer | Euro (€) and USD ($) 2002/03 | Decision tree model | Healed or unhealed | Ulcer successfully healed at 18 weeks | Univariate deterministic, probabilistic | Intervention dominant |
| Guest et al. 2012 [45] | CEA + CUA | Cavilon No Sting Barrier Film | Cavilon durable barrier cream, standard care | UK, NHS | GBP (£) 2009/10 | Decision tree model | Not detailed | % of healed patients at 6 months, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Jemec et al. 2014 [31] | CEA | Silver dressing (Biatain Ag) | Non-silver dressings | UK, NHS | GBP (£) 2012/13 | Decision tree model | Healed vs healing vs no improvement + specialist care | Time to healed wound | Univariate deterministic | Intervention dominant |
| Guest et al. 2015 [36] | CUA | Two-layer cohesive compression bandage (Coban 2) | Other compression systems (Ktwo, Profore) | UK, NHS | GBP (£) 2012/13 | Decision tree model | Not detailed | QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Guest et al. 2018 [27] | CEA + CUA | Collagen-containing dressing | Standard care (compression therapy and wound dressings) | UK, NHS | GBP (£) 2015/16 | Decision tree model | Healed or unhealed | Probability of healing, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Model not detailed | ||||||||||
| Harding et al. 2000 [32] | CEA | Hydrocolloid dressing (Granuflex) | Apligraf, saline gauze | UK, not stated | GBP (£) not stated | Not detailed—“cost-effectiveness model” | Not detailed | % healed in 12 weeks | None | Intervention dominant |
| Kerstein et al. 2001 [33] | CEA | Hydrocolloid dressing (DuoDERM) | Apligraf, saline gauze | USA, not stated | USD ($) 2000 | Not detailed | Not detailed | Proportion of ulcers completely healed | None | Intervention dominant |
| Sibbald et al. 2001 [40] | CEA | Skin substitute (Apligraf) | Profore | Canada, societal | Canadian dollars ($) 1996/97 | Not detailed—“computer-based model” | Not detailed | Number of ulcer days, days to heal | Univariate deterministic | $14 per ulcer-day averted |
| Meaume and Gemmen 2002 [26] | CEA | Hydrocolloid dressing (DuoDERM) | Apligraf | France, health insurance plan | Euro (€) not stated | Not detailed | Not detailed | % patients healed | None | Intervention dominant |
| Panca et al. 2013 [25] | CUA | Sodium carboxymethyl-cellulose dressing (Aquacel) | Four superabsorbent dressings (DryMax Extra, Flivasorb, Kerramax, Sachet S) | UK, NHS | GBP (£) 2003/04 | Not detailed—“decision model” | Not detailed | QALYs | Univariate deterministic, probabilistic | Intervention dominant |
| Guest et al. 2017 [37] | CEA + CUA | Two-layer cohesive compression bandage (Coban 2) | Other compression systems (Ktwo, Profore) | UK, NHS | GBP (£) 2014/15 | Not detailed | Not detailed | % of healed patients, QALYs | Univariate deterministic, probabilistic | Intervention dominant |
CEA cost-effectiveness analysis, CUA cost-utility analysis, EE economic evaluation, GBP British pound, NHS UK National Health Service, QALY quality-adjusted life-years, USD United States dollar