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

Results

Assessment of the Effectiveness

In the literature search, the authors identified 5 randomized clinical trials (as communicated by JJ Aguirre, Biotechnology Institute, Vitoria, Spain, in an email dated September 2011)[8–10,23] in which the treatment period was between 8 weeks and 12 weeks. The DerSimonian and Laird method yielded a P value of 0.0963, indicating a lack of statistical homogeneity. After excluding the study by Knighton et al,[9] which contributed the most to the observed heterogeneity, the combined results gave rates of healing of 46.8% (37.4%-56.2%) among those treated with PRP and of 22.2% (14.4%-30.1%) among those receiving standard care. The estimated probabilities of healing after 48 weeks, as assessed using the Markov model, were 56% (46.3%-65.7%) and 31% (21.9%-40.1%) for the PRP and standard care groups, respectively.

Assessment of Costs

Total ulcer-related costs after 48 weeks of treatment averaged €5224 and €5133 in the PRP and standard care groups, respectively. In the group that received standard care, a high percentage of the figure is due to amputation-related costs, these being higher than in the other group due to the lower rate of healing.

The NNT was 4 (95% CI: 3 to 9), which is statistically significant, and the incremental cost to achieve the healing of 1 additional ulcer, when compared with the results of usual care, would be €364.

Sensitivity Analysis

For the sensitivity analysis, the authors selected the most unfavorable data, that is, the CI percentages corresponding to the measure of effectiveness for each treatment option that minimized the difference in outcomes with the 2 treatments. Hence, for the standard care group the authors used a probability of healing of 40.1% (40.1 ulcers) and for the PRP group a value of 46.3% (46.3 ulcers). With these new figures, the NNT and incremental cost was recalculated. In this case, the NNT was 16 (95% CI: -13 to 5), that is, to achieve healing of 1 additional ulcer, compared to the outcome with usual care, 16 more patients should be treated, and taking the worst case scenario, this would increase expenditure by €1456. In this new scenario, the difference between the 2 treatments is not statistically significant. Further, 1 of the 95% confidence limits is negative, indicating that PRP could have a detrimental effect, (PRP achieves less benefit than conventional treatment, which is referred to as the number needed to harm).[24]

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