Cost-effectiveness analysis of the treatment with compressive therapy in the healing of venous ulcers.
Sarah Lopes Silva Sodré, Glycia de Almeida Nogueira, Alcione Matos de Abreu and 3 others
PMID 36995850WHAT IT FOUND
Healing rates for venous leg ulcers did not significantly differ among multilayer, Unna boot, and short-stretch compression.
A cost model still favored multilayer, while Unna boot was favored at lower spending thresholds.
Key findings
01In the meta-analysis, ulcer healing did not significantly differ between multilayer bandage and short-stretch bandage, or between multilayer bandage and Unna boot.
02In the base-case model, multilayer bandage was the dominant alternative, with an incremental cost-effectiveness ratio of US$ 185.43 in its favor within the US$ 6,186.71 willingness-to-pay threshold.
03Probabilistic sensitivity analysis favored Unna boot when willingness to pay was US$ 190.00 or less, and multilayer bandage from about US$ 200.00 upward.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The model used a hypothetical cohort, so it did not observe real patients or real costs during care. Effectiveness came from international randomized trials, not Brazilian trials, and the Unna boot comparison used only 3 studies. Blinding of participants and professionals was not possible because the compression methods look different. Costs were pre-pandemic, used macro-costing, and excluded professional workforce costs. The probabilistic sensitivity analysis showed substantial uncertainty; results depended on willingness-to-pay thresholds. No budget impact analysis was performed, and alternative model structures were not tested. Healing time data were limited, with 6 studies for multilayer and 2 studies for Unna boot.
The easy way to misread this
Do not read the multilayer cost-effectiveness result as proof that multilayer heals venous ulcers better. The meta-analysis showed no significant difference in healing, and the cost conclusion depends on modeled costs and willingness-to-pay thresholds.