Economic Evaluations of Guideline-Based or Strategic Interventions for the Prevention or Treatment of Chronic Wounds

Background Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce. Objectives Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management. Data Sources Data sources included PubMed, Scopus, HTA, and NHS EED. Study Eligibility Criteria, Participants, and Interventions We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated. Study Appraisal and Synthesis Methods Study and model characteristics and outcomes were extracted into predesigned tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers. Results A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws. Limitations Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies. Conclusions and Implications of Key Findings Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.