The British Journal of Surgery has published the results of a trial that aimed to assess the cost-effectiveness of silver-donating versus non-silver low-adherence dressings in the treatment of venous leg ulcers.
The study recruited 213 patients who were randomly assigned to treatment with a silver dressing (n=107) or a low-adherence dressing (n=106) beneath graduated compression. The primary outcome of the study was healing rate at 12 weeks with secondary outcomes assessing time to healing, quality of life and cost-effectiveness.
There was no statistical difference in primary outcome of healing rate at 12 weeks between the two dressing (59.6% for the silver dressing and 56.7% for the low-adherence dressing). Additionally, there was no difference in healing rates at 6 or 12 months or in quality of life measures.
The authors note that there were differences in demographic data and healing rates between the two centres that participated in the study. The timing of the study also coincided with a period of restructuring in the provision of community services at the trial locations and this impacted upon recruitment. Finally, the study used a generic measure for quality of life.
The authors note, that despite these limitations, the results are consistent with recent systematic reviews that have failed to find any evidence of benefit with antimicrobial dressings. Higher costs were associated with use of silver dressings by an average of £97.85 per patient. The authors therefore conclude that clinicians should use the "least expensive, inert dressings beneath compression therapy as standard care".
Action: Clinicians should be aware of this study. Routine use of antimicrobial dressings for treatment of venous leg ulcers is not evidence based and should be avoided.