Topical antimicrobial dressings for locally infected leg ulcers: late-stage assessment

Recommendations

NICE has recommended that there is not enough evidence to determine whether price variations are justified between different antimicrobial agents in topical antimicrobial dressings for locally infected leg ulcers. See sections 1.2 to1.4 of NICE's guidance on opical antimicrobial dressings for locally infected leg ulcers: late-stage assessment for the other recommendations.

Eligible population for topical antimicrobial dressings

Leg ulcers are the most common chronic wounds in the UK, with varying prevalence estimates across the literature. For example, estimates for venous leg ulcers range from a point prevalence of 0.03% (Urwin et al. 2022) to an estimated annual prevalence of 1.08% (Guest et al. 2020).

The focus of this assessment is the subset of leg ulcers with a local infection. The prevalence of leg ulcers with a local infection is unknown. But the prevalence of infection in leg ulcers of any cause has been reported to be 18% (Vowden and Vowden 2009) and of venous leg ulcers to be 41% (Guest et al. 2020).

Treatment options

There are a range of antimicrobial dressings available to the NHS. For this assessment, NICE considered topical antimicrobial dressings (AMDs) listed in Part 9 of the NHS Electronic Drug Tariff. Decisions about which type of AMD to use depend on choosing a clinically appropriate dressing that meets the needs and preferences of the person with the leg ulcer.

Financial resource impact (cash items)

The unit costs of AMDs vary depending on factors such as size, the specific antimicrobial agent included and the materials the dressing is made from. Treatment costs for leg ulcers will vary depending on the type and number of dressings used during treatment. They will also depend on the need for additional products for wound cleansing, secondary dressings and visits by a healthcare professional to change the dressings.

Implementation of the guidance may save costs because it recommends selecting the least expensive option if more than one AMD is appropriate to treat a locally infected leg ulcer.

Costs will vary depending on local procurement policies. NICE has developed a cost calculator to help healthcare professionals estimate the total overall cost of using the clinically appropriate AMD options. This uses local data to establish and select the least expensive dressing option.

The clinical presentation of each person can vary, so care needs will vary from person to person. The cost calculator can be used on a per‑person basis to estimate the treatment costs of using a suitable selection of up to 15 AMD options ranked by increasing cost. The user guide worksheet provides information on how to use the cost calculator.

Capacity impact

Using AMDs that minimise the frequency of visits by a healthcare professional may help free up healthcare professional time.

Key information

About this resource impact summary report

This resource impact summary report accompanies the NICE guidance on topical antimicrobial dressings for locally infected leg ulcers: late-stage assessment and should be read with it.

ISBN: 978-1-4731-7102-2