Cost effectiveness analysis of larval therapy for leg ulcers

Soares, Marta O., Iglesias, Cynthia P., Bland, J. Martin, Cullum, Nicky, Dumville, Jo C., Nelson, E. Andrea, Torgerson, David J., Worthy, Gill and On behalf of the VenUS II team (2009) Cost effectiveness analysis of larval therapy for leg ulcers. British Medical Journal, 338 . doi:10.1136/bmj.b825

Author Soares, Marta O.
Iglesias, Cynthia P.
Bland, J. Martin
Cullum, Nicky
Dumville, Jo C.
Nelson, E. Andrea
Torgerson, David J.
Worthy, Gill
On behalf of the VenUS II team
Title Cost effectiveness analysis of larval therapy for leg ulcers
Journal name British Medical Journal
ISSN 0007-1447
Publication date 2009-01-01
Sub-type Article (original research)
DOI 10.1136/bmj.b825
Open Access Status DOI
Volume 338
Total pages 8
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
Formatted abstract
Objective To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers.

Design Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation.

Population Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue.

Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel.

Main outcome measure The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis).

Results The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, £96.70 (€109.61; $140.57) more per participant per year (95% confidence interval −£491.9 to £685.8) than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval −0.95 to 31.91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval −0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at £8826 per QALY gained and £40 per ulcer-free day. Considerable uncertainty surrounds the outcome estimates.

Conclusions Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel.

Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number b825.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
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Created: Wed, 21 May 2014, 00:53:33 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work