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Review
. 2019 Aug;17(4):453-465.
doi: 10.1007/s40258-019-00465-8.

Mepilex Border Sacrum and Heel Dressings for the Prevention of Pressure Ulcers: A NICE Medical Technology Guidance

C Marshall  1 , J Shore  1 , M Arber  1 , M Cikalo  1 , T Oladapo  2 , A Peel  1 , R McCool  1 , Michelle Jenks  3
Affiliations
Review

Mepilex Border Sacrum and Heel Dressings for the Prevention of Pressure Ulcers: A NICE Medical Technology Guidance

C Marshall et al. Appl Health Econ Health Policy. 2019 Aug.

Abstract

Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The dressings are used in addition to standard care protocols for pressure ulcer prevention. The National Institute for Health and Care Excellence (NICE) selected Mepilex Border Sacrum and Heel dressings for evaluation. The External Assessment Centre (EAC) critiqued the company's submission. Thirteen studies (four randomised controlled trials and nine nonrandomised comparative studies) were included. The majority of studies compared Mepilex Border Sacrum dressings (plus standard care) with standard care alone. Comparative evidence for Mepilex Border Heel dressings was limited. A meta-analysis indicated a non-statistically significant difference in favour of Mepilex Border Sacrum dressings for pressure ulcer incidence [RR 0.51 (95% CI 0.22-1.18)]. The company produced a de novo cost model, which was critiqued by the EAC. After the EAC updated input parameters, cost savings of £19 per patient compared with standard care alone for pressure ulcer prevention were estimated with Mepilex Border dressings predicted to be cost saving in 57% of iterations. The Medical Technologies Advisory Committee reviewed the evidence and judged that, although Mepilex Border Heel and Sacrum dressings have potential to prevent pressure ulcers in people who are considered to be at risk in acute care settings, further evidence is required to address uncertainties around the claimed benefits of the dressings and the incidence of pressure ulcers in an NHS acute-care setting. After a public consultation, NICE published this as Medical Technology Guidance 40.

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Conflict of interest statement

This summary of the Medical Technology Guidance was produced following publication of the final guidance report. This summary has not been externally peer reviewed by Applied Health Economics and Health Policy. Seven of the authors (CM, JS, MA, MC, AP, RM and MJ) work or worked for the EAC, but otherwise have no conflicts of interest. TO is an employee of NICE.

Figures

Fig. 1
Fig. 1
EAC’s PRISMA diagram. EAC external assessment centre
Fig. 2
Fig. 2
Pooled analysis: number of patients who developed pressure ulcers (Mepilex Border Sacrum vs Standard Care). CI confidence interval, df degrees of freedom
See this image and copyright information in PMC

References

    1. National Institute for Health and Care Excellence (NICE) Medical technologies evaluation programme methods guide. London: NICE; 2017. - PubMed
    1. National Institute for Health and Care Excellence (NICE) Medical technologies evaluation programme process guide. London: NICE; 2017. - PubMed
    1. National Institute for Health and Care Excellence. Mepilex Border Heel and Sacrum dressings for preventing pressure ulcers. 2019. https://www.nice.org.uk/guidance/mtg40. Accessed 11 Jan 2019.
    1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: quick reference guide. Haesler E, editor. Australia: Cambridge Media, Perth; 2014. http://www.npuap.org/wp-content/uploads/2014/08/Quick-Reference-Guide-DI...
    1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. international guideline: pressure ulcer treatment technical report. 2009.

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