Cost-Effectiveness of Hypochlorous Acid Preserved Wound Cleanser versus Saline Irrigation in Conjunction with Ultrasonic Debridement for Complex Wounds.

Peter J Mallow,Martin C Robson,John M Hiebert

doi:10.36469/001c.28429

Abstract

Objective: Low-frequency ultrasound debridement with irrigation is an effective method of wound bed preparation. A recent clinical study compared hypochlorous acid preserved wound cleanser (HAPWOC) to saline and found HAPWOC to be a more effective adjunct to low frequency ultrasound debridement. However, HAPWOC has an added cost. The primary objective of this study was to assess the cost-effectiveness of HAPWOC as an irrigation modality with low-frequency ultrasound debridement for the treatment of severely complex wounds that were destined to be closed primarily via a flap. The secondary objective of this study was to estimate the number needed to treat (NNT) to avoid a wound-related complication and its expected cost per NNT.Methods: A patient-level Monte-Carlo simulation model was used to conduct a cost-effectiveness analysis from the US health system perspective. All clinical data were obtained from a prospective clinical trial. Cost data were obtained from the publicly available data sources in 2021 US dollars. The effect measure was the avoidance of wound-related complications at 14-days post-debridement. The primary outcome was the incremental cost-effectiveness ratio (ICER), a measure of the additional cost per benefit. The secondary outcomes were the NNT and expected cost per NNT to avoid one complication (complementary to the ICER in assessing cost-effectiveness). Deterministic and probabilistic sensitivity analyses (PSA) were performed to gauge the robustness and reliability of the results.Results: The ICER for HAPWOC versus saline irrigation was US$90.85 per wound complication avoided. The expected incremental cost per patient in the study and effect was US$49.97 with 55% relative reduction in wound-related complications at day 14 post debridement procedure. The NNT and cost per NNT were 2 and US$99.94, respectively. Sensitivity analyses demonstrated that these results were robust to variation in model parameters.Conclusion: HAPWOC was a cost-effective strategy for the treatment of complex wounds during ultrasonic debridement. For every two patients treated with HAPWOC, one complication was avoided.

Highlights

Wound bed preparation (WBP) has been a holistic and structured approach to determine which wounds are healable and best practices to consider during treatment.[1]
The primary objective of this study was to assess the cost-effectiveness of hypochlorous acid preserved wound cleanser (HAPWOC) as an irrigation modality with low-frequency ultrasound debridement for the treatment of severely complex wounds that were destined to be closed primarily via a flap
For those complex wounds that can be definitively closed with primary closure techniques involving grafts, approximations, or pedicle flaps, the quality of the WBP is of paramount importance

Summary

Introduction

Wound bed preparation (WBP) has been a holistic and structured approach to determine which wounds are healable and best practices to consider during treatment.[1] For healable complex wounds, WBP promotes debridement as a means to promote healing and reduce the time to reepithelization. A key element of WBP is physical removal of necrotic tissue. In addition to the removal of necrotic tissue, a key benefit of debridement is the removal of bacterial laden tissue.[2,3] For those complex wounds that can be definitively closed with primary closure techniques involving grafts, approximations, or pedicle flaps, the quality of the WBP is of paramount importance.

Methods

Results

Discussion

Conclusion