Cost-effectiveness analysis in comparing alginate silver dressing with silver zinc sulfadiazine cream in the treatment of pressure ulcers

Abstract

Background: The treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD) and silver zinc sulfadiazine cream (AgZnSD) with regard to wound healing and cost-effectiveness.

Methods: Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospective, randomized controlled trial. The patients were randomized to receive one of the two dressings for an eight-week period. The criteria of efficacy were based on the Pressure Ulcer Scale for Healing (PUSH) scoring tool. The cost of treatment was also assessed.

Results: Twenty patients (12 women and 8 men) were randomly assigned to receive either AlSD (n=10) or AgZnSD cream (n=10). The demographic data and wound characteristics were comparable in the two groups. The two groups showed no significant difference in the reduction of PUSH score, wound size, or volume of exudate. The tissue type score was significantly lower in the AlSD group (3.15±0.68-1.85±0.68 vs. 2.73±0.79-2.2±0.41; P=0.015). The cost of treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively; P<0.0001).

Conclusions: Alginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

Keywords: Calcium alginate; Cost effectiveness; Pressure ulcer.

Fig. 1

Flow diagram of the study population The flow diagram shows the allocation pattern of the population. Twenty-six patients were eligible in this study; four were excluded due to anticoagulant medication (n=3) and, one was excluded because of an active infection around the pressure ulcer (n=1). Two patients died during the study.

Fig. 2

Wound area This representative figure shows the cumulative improvement in the wound area (cm²) by subject over time (weeks). A wound size reduction was found in both groups with no statistically significant difference (P=0.504). AlSD, alginate silver dressing; AgZnSD, silver zinc sulfadiazine cream.

Fig. 3

PUSH scores This representative figure shows the cumulative improvement in the PUSH score by subject over time (weeks). A PUSH score reduction was found in both groups with no statistically significant difference (P=0.402). PUSH, Pressure Ulcer Scale for Healing; AlSD, alginate silver dressing; AgZnSD, silver zinc sulfadiazine cream.

Fig. 4

Exudate amount This representative figure shows the cumulative improvement in exudates amount by subject over time (weeks). The exudate amount was reduced in both groups with no statistically significant difference (P=0.557). AlSD, alginate silver dressing; AgZnSD, silver zinc sulfadiazine cream.

Fig. 5

Tissue type This representative figure shows the cumulative improvement in the tissue type by subject over time (weeks). The tissue type was improved in both groups with a statistically significant improvement in the alginate silver wound dressing (AlSD) group (P=0.015). AgZnSD, silver zinc sulfadiazine cream.

Fig. 6

Cost of treatment This representative figure shows the comparison of cost of treatment between the two groups. At the end of the study, the cost of treatment in the alginate silver wound dressing (AlSD) group was reduced compared to the silver zinc sulfadiazine cream (AgZnSD) group with a statistically significant difference (P<0.001).

Fig. 7

Cost of treatment and dressing unit cost This figure shows the relationship between the dressing unit cost and overall cost of treatment. Increments and decrements in multiples of 10% of the dressing unit cost affected the total cost of treatment. The total cost of treatment of the silver zinc sulfadiazine cream (AgZnSD) group was greater than that of the alginate silver wound dressing (AlSD) group unless the dressing unit cost was reduced by more than 20%.

Fig. 8

Case study 1 A 84-year-old female with a grade III sacral pressure ulcer. She had underlying hypertension, dyslipidemia, and old ischemic stroke with a totally dependent status. She had suffered from a sacral pressure ulcer for 5 months. She was treated with alginate silver dressing. After an eight-week period of treatment, the wound size had been reduced from 20 to 12 cm². (A) At the first week. (B) At the second week. (C) At the fourth week. (D) At the eighth week.

Fig. 9

Case study 2 An 80-year-old female with a grade III sacral pressure ulcer. She had underlying of diabetes mellitus. She suffered from a sacral pressure ulcer with necrotic tissue for 15 days. She received debridement, and the wound was treated with alginate silver dressing. Eight weeks after treatment, the wound size was reduced from 20 to 3 cm². (A) At the first week before debridement with some necrotic tissue. (B) At the eighth week.