Platelet-rich Plasma in Skin Ulcer Treatment

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

Wounds. 2013;25(9):256-262.

Conclusion

The authors conclude that the use of PRP for the treatment of skin ulcers is cost effective; the extra cost for achieving the healing of 1 more ulcer than with usual care would be €364, much lower than the overall long-term costs of treating an ulcer with the usual approach of standard care without PRP (€5133).

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Table 1. Clinical trials included in the meta-analysis.
Authors	Groups	Focus of the treatment	Period of treatment (weeks)	Number of patients and ulcers treated	Healed n (%; 95% CI)	P value
Driver et al,²³ 2006	Control: Usual care Intervention: autologous PRP	Diabetic ulcers	12	Control: 19 PRP: 16 (adjusted for the initial size of the ulcer)	8 (42.1; 19.9–64.3) 13 (81.3;54.5–96.0)	P = 0.036
Friese et al,⁸ 2007	Control: Usual care Intervention: autologous PRP	Diabetic ulcers	12	Control: 21 PRP: 20	5 (24;5.7–42.0) 11 (55;33.2–76.8)	P < 0.005
>>>Knighton et al,⁹ 1990	Control: Usual care Intervention: autologous PRP	Chronic ulcers	8	Control: 11 patients (13 ulcers) PRP: 13 patients (21 ulcers)	2/13 (15.4;1.9–45.5) 17/21 (81;64.2–97.7)	P < 0.0001
Aguirre (personal communication)	Control: Usual care Intervention: PRGF	Chronic ulcers	8	Control:11 PRGF: 12	3 (23; 1.0–53.6) 6 (50; 21.7–78.3)	P = 0.4
*Aguirre (personal communication) Estimated at 12 weeks				Control:11 PRGF: 12	5 (45.5;16.1–74.9) 9 (75;50.5–99.5)
Steed DL,¹⁰ 1995	Control: placebo gel Intervention: rhPDGF	Chronic diabetic ulcers	20	Control: 57 PDGF: 61	14 (24.6; 13.4–35.7) 29 (47.6; 35.1–60.1)	P = 0.01
**Steed DL Extrapolated to 12 weeks				Control: 57 PDGF: 61	6 (10.5; 3.0–18.5) 18 (29.5;18.1–41.0)	P = 0.0198

>>>Study was not included in the final cost-effectiveness analysis; *Estimation of the results at 12 weeks from the data at 8 weeks; **Extrapolation from the graph.

Table 2. Probabilities of changing between health status categories.
Treatment	At 12 weeks		At 24 weeks		At 36 weeks		At 48 weeks		Recurrence*	Amputation**
Treatment	Healed	Nonhealed	Healed	Nonhealed	Healed	Nonhealed	Healed	Nonhealed	Recurrence*	Amputation**
Usual treatment	0.222	0.778	0.08	0.92	0.072	0.928	0.064	0.936	0.26	0.16
Usual treatment + PRP	0.468	0.532	0.123	0.877	0.042	0.958	0.038	0.962	0.04	0.16

*Percentage relative to cases in which the ulcer healed. **Percentage relative to cases in which the ulcer did not heal.

Table 3. Direct costs included in the cost-effectiveness analysis per ulcer.
	Usual care	Usual care + PRP
Number of visits	24 (wound cleansing, debridement, application of dressings)	12 (wound cleansing, debridement, application of dressings)	12 (wound cleansing, debridement, application of dressings + PRP)
Duration of the appointment	15 min	15 min	60 min
Cost of the appointment	€3.42 *	€3.42 *	€13.69*
Change of Dressing	€7.20**	€7.20**	€7.20**
Kit preparation PRP		–	€132.90***
TOTAL	€254.88	€1972.92
Mean cost of amputations	€41163****

*Salary of the nursing staff of the public health system in 2007 after conversion from US dollars to euros.²⁰ **Average costs of the material necessary for changing dressings based on data from Sweden and United Kingdom.²¹ *** Average price of a PRP kit per session.
****Cost of amputations.²²
The conversion was made using the official value of the US dollar and the euro of European Central Bank on October 26, 2012.

Table 4. Ulcers healed at 12 weeks: results of the studies included in the meta-analysis.
Study	Intervention group Control group
	Healed		Nonhealed		Healed		Nonhealed
	N (%)	95% CI	N (%)	95% CI	N (%)	95% CI	N (%)	95% CI
Driver et al,²³ 2006	13 (81.3)	54.5–96.0	3 (18.8)	4.1–45.7	8 (42.1)	19.9–64.3	11 (57.9)	35.7–80.1
Friese et al,⁸ 2007	11 (55.0)	33.2–76.8	9 (45.0)	23.2–66.8	5 (23.8)	5.6- 42.0	16 (76.2)	58.0–94.4
Aguirre (personal communication)*	9 (75.0)	50.5–99.5	3 (25.0)	0.5–49.5	5 (45.5)	16.0–74.9	6 (54.5)	25.1–84.0
Steed DL,¹⁰ 1995**	18 (29.5)	18.1–41.0	43 (70.5)	59.1–81.9	6 (10.5)	3.0–18.5	51 (89.5)	81.5–97.4
Total	51 (46.8)	37.4–56.2	58 (53.2)	43.8–62.6	24 (22.2)	14.4–30.1	84 (77.8)	69.9–85.6