Polihexanide and Betaine (PSGX) Containing Solution Versus Saline for the Treatment of Leg Ulcers: A Comparative Cost Analysis Using Real-World Data From England

BACKGROUND: Chronic lower limb ulcers (CLLUs) are associated with substantial clinical and economic burdens. Polihexanide and betaine (PSGX) containing cleanser is a well-known alternative to saline and water for wound cleansing in clinical practice. This study provides further evidence on its health economic advantages.

OBJECTIVES: To estimate the difference in healthcare resource use (HCRU) and cost between patients initiated on PSGX compared to saline solution.

METHODS: In this retrospective cohort study, individuals with a diabetic, venous, or unspecified CLLU prescribed a wound cleansing solution were identified from the CPRD (Clinical Practice Research Datalink) Aurum, linked with Hospital Episode Statistics and Office of National Statistics death registrations datasets, between 01/04/2007-31/03/2020. In an intention-to-treat analysis, patients initially prescribed PSGX products were propensity matched to patients initially prescribed saline. All-cause healthcare costs and selected HCRU over the first treatment year were compared and adjusted for exposure year, region, and dressing size using multivariable generalized linear modelling with gamma family and identity link.

RESULTS: Of the 60,140 patients with a wound cleansing prescription, 990 PSGX patients and 8,522 saline patients met the inclusion criteria. The adjusted mean all-cause cost was £ 605 lower for PSGX treatment (£ -605; 95% CI £ -1,227 to £ 45; p=0.058). On average, the PSGX group had 0.44 fewer inpatient admissions (-0.44; 95% CI -0.54 to -0.35; p<0.001), 1.1 fewer outpatient attendances (-1.1; 95% CI -1.3 to -0.89; p<0.001), and 2.5 fewer primary care consultations (-2.5; 95%CI -3.2 to -1.9; p<0.001) within the first year.

CONCLUSIONS: Adjusted mean all-cause HCRU and costs were substantially lower amongst patients initiated on PSGX compared with matched saline controls, with a statistically significantly difference in HCRU. This real-world study provides unique insights into the economics of CLLU treatment in clinical practice and substantiates evidence on the cost-effectiveness of PSGX.