Cost-Effectiveness Analysis of the Use of Negative Pressure Wound Therapy in the Treatment of Diabetic Foot Disease - A Systematic Literature Review

OBJECTIVES: A systematic literature review was conducted to find studies that calculated preference-based utility weights useful for building a decision tree for cost-effectiveness analysis (CEA) of chronic or difficult-to-heal wounds (CDHW).

METHODS: The search of studies published between January 2000 and May 2022 was conducted in PubMed, using a structured search protocol containing terms related to the clinical condition and quality of life. Additionally, a free search was performed in Google Scholar and the Global Health Cost Effectiveness Analysis (GH CEA) Registry. The review is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

RESULTS: Seven references were identified in the MEDLINE search, three of which were analyzed in depth: 1) A cross-sectional study of people with CDHW, during nursing consultation, in Brazil. The quality of life was assessed by the Quality-of-Life Index - wound version and the data were analyzed by t-test and Mann-Whitney test. 2) 27 patients who attended two specialized outpatient services in Brazil and interviewed at baseline and after 12 weeks of treatment using the questionnaires Ferrans & Powers Quality of Life Index - Wound Version, Numerical Pain Scale, Global Assessment of Change Scale, Pressure Ulcer Scale for Healing and sociodemographic and clinical data. Data were analyzed using Spearman's coefficient, Mann-Whitney test, and linear regression. 3) A study of 100 patients with CDHW from a university hospital and a Basic Health Unit in southern Brazil aimed to evaluate changes in the quality of life. The mean values of the domains of the Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound instruments were compared with sociodemographic variables of age, sex, and education.

CONCLUSIONS: In summary, the results of the literature search for outcome assessment did not yield estimates of utility weights associated with the treatment of CDHW.