Platelet-rich Plasma in Skin Ulcer Treatment

Raquel Cobos Campos, Pharm; Naiara Parraza Diez, Pharm, PhD; Felipe Aizpuru Barandiaran, MD, PhD

Disclosures

Wounds. 2013;25(9):256-262. 

In This Article

Abstract and Introduction

Abstract

Introduction. Chronic vascular ulcers are associated with a high use of resources. Conventional treatment consists of wound cleansing, necrotic tissue debridement, prevention, diagnosis, and, if necessary, treatment of infection and dressing application; although conventional treatment has limited effectiveness with wound healing (around 15-30%).[8–11] Platelet-rich plasma, used in various fields of medicine, improves chronic vascular ulcer results, but is more expensive. Methods. A cost-effectiveness analysis was performed using a 48-week period comparing platelet-rich plasma with standard care. A meta-analysis of papers identified by a literature search was done.

Results. A combined measure of effectiveness at 12 weeks for each treatment option was calculated and served as the basis for estimating the probability of healing at 48 weeks with a Markov model.

Conclusions. The probability of healing and associated costs were 56% and €5224 using platelet-rich plasma and 31% and €5133 with usual care. The incremental cost that must be assumed to achieve additional healing with platelet-rich plasma is €364.

Introduction

Chronic vascular ulcers require multidisciplinary management that is associated with a high use of resources, especially in primary care. It is estimated that in Western countries 1% of adults will have a chronic vascular ulcer at some stage in their lives, the prevalence being 1.3 to 3 individuals out of 1000.[1] In Spain, according to the first national study on leg ulcers carried out between 2002 and 2003, the prevalence of vascular ulcers was found to be 1.65 per 1000.[2]

Vascular ulcers can be arterial, venous, or both, with the most common etiology being venous and representing 80%-90% of all vascular ulcers.[3,4] Venous ulcers tend to be persistent—among patients with venous ulcers, 30% have a > 5-year history of this condition and an estimated 72% rate of recurrence.[5,6] The conventional treatment of vascular ulcers consists mainly of wound cleansing; debridement of necrotic tissue; prevention; diagnosis; and, if necessary, treatment of infection and application of dressings.[7] The effectiveness of the conventional treatment is still relatively low, around 15%-30%.[8–11,22] Moreover, the mean duration of skin ulcers is approximately 1 year, indicating the seriousness of the problem for many patients, given the associated pain and disability.

The use of platelet-rich plasma (PRP) and plasma rich in growth factors (PRGF) is a relatively new approach considered clinically useful in various fields of medicine (ie, dentistry, traumatology, cosmetic surgery, ophthalmology, and dermatology). Platelets contain proteins, known as growth factors, that trigger biological effects including directed cell migration (ie, chemotaxis), angiogenesis, and cell proliferation and differentiation, which are key in the processes of tissue repair and regeneration. Various studies have been published on the role of platelet concentrates in the treatment of skin ulcers with positive results in favor of this technology.[8–13] However, since this biotechnological approach has higher associated costs than conventional practice, it is necessary to assess whether it is economically justifiable through cost-effectiveness analysis comparing it with the usual treatment provided in clinical practice.

The current use of health care resources for the treatment of vascular ulcers is very high, both because complete closure of the wound is very difficult to achieve and because the ulcers tend to recur.[14] In a study carried out by Ragnarson Tennvall et al,[15] it was estimated that the average cost of standard treatment for venous ulcers was €71 per patient per week, excluding inpatient care, and €103 in total. In the United Kingdom, the direct cost of vascular leg ulcers to the National Health Service has been estimated to be €400 million sterling.[16] Given all this, it necessary to analyze different treatment options, in terms of their associated costs and effectiveness.

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