ACTICOAT^◊ Case Studies

ACTICOAT (with SILCRYST^◊ Nanocrystals) and Health Economics

ACTICOAT Retrospective/Prospective Cost Analysis

To better understand the cost-effectiveness of ACTICOAT at an individual patient level, a retrospective/prospective treatment cost analysis was conducted on many of the case studies represented in this booklet.

This analysis compares the cost of treatment of a patient's wound to date using conventional therapy (without achieving healing) with the cost of healing a wound using ACTICOAT as an adjunct therapy.

The objective of this cost analysis is to put the purchase price of ACTICOAT into perspective with the cost of conventional treatment the patient has received to date in the management of their wound. One of the assumptions underpinning the cost analysis is that the pattern and cost of wound care over the period leading up to the current point in time is likely to be duplicated for a similar period after this point if the wound care treatment remains unchanged. i.e. if you continue with the same treatment regime it is reasonable to expect the same health outcomes.

The implication of this cost analysis for the healthcare system is that early intervention with ACTICOAT on patients who are unresponsive to conventional wound care management is likely to avoid indefinitely ongoing consumption of healthcare resources, at the levels identified in Table 1.

Good data are available which show the average weekly cost of conventional treatment of various wound types. (UK treatment patterns and costs (2000)) Table 1. Weekly Treatment Costs

Figures compiled in 2003

Retrospective Costs

The patient information used for retrospect costs was 'weeks of treatment'.

The retrospective treatment cost to date was calculated using the weeks of treatment for a patient multiplied by the average weekly cost to treat the applicable clinical indication (see Table 1). It is important to recognise that this cost represents the cost of treating a patient without achieving a healed wound.

Prospective Costs

The patient information used for prospective costs was 'weeks of treatment with ACTICOAT and 'time to heal'.The prospective treatment cost was calculated using the number of pieces of ACTICOAT used multiplied by the purchase price (see Table 2).

Only the product cost of ACTICOAT is considered as the additional cost to heal the ulcer as the cost of ongoing clinic visits and conventional wound management products would have been incurred irrespective of treatment choice. ( ACTICOAT is an adjunct therapy, used in combination with conventional wound management products) It is important to note that this cost represents the cost to heal a patient's wound, with the use of ACTICOAT.

Table 2. ACTICOAT Price

ACTICOAT (with SILCRYST^◊ Nanocrystals) and the treatment of burn wounds of the hands

Introduction
This case study illustrates the use of ACTICOAT to treat superficial and partial thickness burns of the hands.

Patient
The patient was a 21 year old male who attended the emergency department with burns to both hands. The burns had been caused by the patient attempting to push objects into a bonfire he had lit to dispose of rubble. The wounds had been immediately cooled under running water. The patient presented with superficial burns to the right hand and a partial thickness burn on the extensor side of the left hand.

Treatment
The blisters on the left hand were ablated and a paraffin gauze dressing with SSD was applied and covered with pads and gauze bandages. Subsequently the patient received a tetanus booster. The patient was told to return the following day. On day 2, the primary dressing was removed under significant pain, the patient was treated with a hand bath and further blisters were removed. It was decided to apply the ACTICOAT dressing. The ACTICOAT was moistened with distilled water and applied to the wound. When the patient returned after a further 2 days, the wound appeared free from infection. The back of the hand was slightly swollen, so a wound swab was taken. This revealed discrete colonisation with Staphylococcus, but it was decided that oral antibiotic therapy was unnecessary. ACTICOAT was applied in a similar fashion for a further 2 days.

Outcome
On the 5th day following the accident, the beginning of epithelialisation was observed. The dressing regime was changed to CUTINOVA^◊ Thin (Fig. 3). After 14 days, the wound was completely re-epithelialized and only skin care was required (Fig. 4).

Fig1	Fig 2
Fig 3	Fig 4

ACTICOAT (with SILCRYST^◊ Nanocrystals) in the treatment of an acute wound in an infant

Introduction
This case study illustrates the use of ACTICOAT to treat an acute wound in an infant.

Patient
The patient was a 3 month old female, operated on for an exomphalos. At day 14 post surgery, part of the abdominal sutures opened due to tension. The infant was taken to surgery and sutures were put in place again. Two lateral incisions were created in order to relieve the tension in the abdominal wall (see Fig 1).

Treatment
ACTICOAT was moistened and applied to the lateral incision wounds (see Fig 2).

Outcome
Complete wound closure was achieved at day 16 (see Fig 3).

Fig 1	Fig 2
Fig 3

Use of ACTICOAT (with SILCRYST^◊ Nanocrystals) in the treatment of a traumatic wound

Introduction
This case study illustrates the use of ACTICOAT on a traumatic lesion.

Patient
The patient was an 11 year old boy with an infected open tibia fracture. The trauma was the result of being run over by an ambulance and infection of the wound had occurred (Fig. 1).

Treatment
Aggressive surgical debridement of the wound was carried out, exposing 15cm of the tibia (Fig. 2). The wound was then covered with a skin substitute/dermal regenerator and moistened ACTICOAT applied (Fig. 3). Gauze and a multi-perforated catheter were employed to keep the ACTICOAT moist (Fig. 4). Dressing changes occurred every four days on an outpatient basis for a total of five weeks.

Outcome
After five weeks of using ACTICOAT, there were no signs of infection and the wound had almost completely closed.

Fig1	Fig 2
Fig 3	Fig 4
Fig 5	Fig 6

ACTICOAT and ACTICOAT 7 (with SILCRYST^◊) Nanocrystals on a paediatric scald of the chest and flank

Introduction
This case study illustrates effective use of ACTICOAT and ACTICOAT 7 in the healing of a paediatric scald, demonstrating patient comfort and savings in both nursing time and use of analgesia.

Patient
The patient was a 20 month old boy with a superficial/partial thickness burn to the chest and flank. The wound was painful with blisters evident on the surface of the skin (Fig. 1).

Treatment
ACTICOAT was moistened and applied to the burn, then covered with a MELOLIN^◊ dressing. The patient was then discharged in the care of the parents. No analgesia was required. After three days, the ACTICOAT was removed and significant healing of the burn wound was evident. The wound was clean and moist and no analgesia was required. At this time, an ACTICOAT 7 dressing was applied and the same regime followed for the next seven days.

Outcome
Healing of the burn occured in just over two weeks. (Fig. 2). Significant savings in both nursing time, analgesia and in-patient stays were identified. Patient comfort and family satisfaction were noteworthy.

Fig 1	Fig 2

Case Study 5 - Decreasing the risk of limb amputation (PDF - 139kb)

ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) and the management of diabetic neuropathic foot ulceration

Introduction
This case study illustrates the use of ACTICOAT 7 in the management of neuropathic foot ulceration to prepare the wound bed for healing.

Patient
The patient was a 46 year old male with a long history of insulin-dependent diabetes. Glycaemic control had been variable over the years, and there was evidence of peripheral sensory neuropathy affecting both limbs. Between 1992 and 2000, the patient suffered at least six episodes of diabetic ulceration of the feet, one of which was severe enough to lead to amputation of the 4th toe on the left foot. A second amputation procedure was carried out in 2000 following a period of ulceration and severe infection on the left 5th metatarsal head area. The 5th toe and the metatarsal head were amputated resulting in a large deep granulating wound. This wound was skin grafted with excellent results and healing was achieved in 4 weeks. However, in April 2001 the patient became concerned regarding infection around the area of the previous skin graft site. The wound was malodorous with a moderate amount of discharge (see Fig. 1).

Treatment
In January 2002 the wound was sharp debrided, dressed with moistened ACTICOAT 7, covered with a polyurethane foam and pressure relief was achieved using crutches. Glycaemic control was monitored and the patient was reviewed weekly. At each review the patient was carefully monitored for signs of cellulitis and infection of the limb before redressing the wound.  

Outcome
One month later the wound was found to be clinically free of infection. There was minimal discharge and the wound was odor free. The wound was almost closed with some residual unevenness around the area of the graft (see Fig. 2). Hospital admission had been avoided.

Fig 1	Fig 2

Cost Analysis

The patient had approximately 12 months of conventional treatment for his diabetic foot ulcer, with the ulcer remaining unhealed.

A 4-piece course of ACTICOAT 7 resulted in an ulcer that was reduced in size by 93% within 4 weeks.

This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.

ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) and the management of an acutely infected venous leg ulcer Introduction

This case study demonstrates the use of ACTICOAT 7 in the management of an acutely infected venous leg ulcer.

Patient
The patient was an 82 year old male, admitted to hospital with a fracture of the distal portion of his left femur and a suspected deep vein thrombosis and cellulitis of his right leg. He had a medical history of bilateral total knee replacements, myeloproliferative disorder, and a mild right-sided weakness from a cerebrovascular accident. Prior to being admitted to the hospital, the patient had been mobile with the aid of a walking stick. The patient's right leg had become extremely painful and the skin was broken and inflamed (Fig. 1). Infection could be seen tracking up the leg and the ulcerated area bled very easily on examination and on removal of the previous dressings (a Hydrofiber™ dressing). The patient was extremely concerned that he was going to lose his leg as the deterioration had been very rapid.

Treatment
A wound swab was taken and the ulcer was irrigated. Moistened ACTICOAT 7 was then applied. Systemic antibiotic treatment was also commenced. After two days of this treatment regimen, the dressing was removed to allow for examination of the wound. The wound was redressed with Intrasite* Gel and moistened ACTICOAT 7.

Outcome
After 2 days the patient reported a dramatic reduction in pain.
After 5 days the ulcer showed considerable improvement. The INTRASITE^◊ Gel had maintained the ulcer in a moist environment and the wound bed was clearly looking healthier. The ulcer had started to over-granulate, so a change of dressing regime was warranted. A new ACTICOAT 7 dressing was applied along with 2 layers of foam dressing to provide a little pressure to the wound bed. The dressing remained in place for 7 days. By day 14 the over-granulation had stopped and the wound was reduced in size (Fig. 2). The patient was discharged from hospital and management of the ulcer passed to the community nursing team.

FIg 1	Fig 2

Cost Analysis
The patient had approximately 2 months of conventional treatment for his venous leg ulcer, with the ulcer remaining unhealed.
A 4-piece course of ACTICOAT 7 resulted in a healed ulcer within 4 weeks.

^This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.

Management of a pressure ulcer of the hip with ACTICOAT 7 (with SILCRYST^◊ Nanocrystals)

Introduction
This case study illustrates the use of ACTICOAT 7 to heal a pressure ulcer that had failed to respond to previous therapy.  

Patient
The patient was an 85 year old male, who was partially bedridden and suffering from malnutrition and cachexia. A pressure ulcer had formed on the hip and had been present for 5 months. The woundbed was 95% sloughy, with signs and symptoms of infection, including increased redness, increased exudate and pain (Fig. 1). Previous treatment had involved topical antibiotics and gauze. A deep swab revealed the presence of Staphylococcus aureus, prompting administration of systemic antibiotics twice daily for 7 days.  

Treatment
ACTICOAT 7 was moistened, applied to the wound and covered with ALLEVYN Dressing changes were carried out every 7 days.  

Outcome
A visual difference could be seen after 20 days (Fig. 2) and complete closure was achieved in 5 weeks (Fig. 3).

Fig 1	Fig 2
Fig 3

Cost Analysis

The patient had approximately 5 months of conventional treatment for his grade 3 pressure ulcer, with the ulcer remaining unhealed. A 5-piece course of ACTICOAT 7 resulted in a healed ulcer within 5 weeks.

This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.

ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) and the management of an infected thigh stump

Introduction
This case study illustrates the use of ACTICOAT 7 in the management of an infected open thigh stump in a diabetic patient.  

Patient
The patient was a 45 year old male with peripheral arterial occlusion, who had undergone amputation to both lower legs. The right leg had been further amputated up to the thigh and the wound was now infected and was failing to heal (Fig. 1 and 2). In addition, massive fat necrosis had occurred. The patient was also a diabetic and a smoker of approximately 60 cigarettes per day.  

Treatment
Surgical debridement of the wound was carried out to remove necrotic tissue. The wound was then dressed with moistened ACTICOAT 7, on top of which a cavity dressing was placed (Fig.3) and the patient's diabetes was controlled appropriately.

Outcome
Closure was achieved in 7 weeks (Fig.4).

FIg 1	Fig 2
Fig 3	Fig 4

ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) and the management of diabetic neuropathic foot ulceration 

Introduction
This case study illustrates the use of ACTICOAT 7 in the management of a diabetic foot ulcer.

Patient
The patient was an 80 year old male with a history of diabetes and an ulcer on the heel of his left foot (Fig. 1). The ulcer had been present for 1 year, was 20% black necrotic and 80% granulated. The dimensions of the wound were 6cm wide, 7cm long and 1cm deep. Skin surrounding the wound was reddened, macerated and oedematous, although it was intact. There was a large amount of exudate and the ulcer was malodorous. In addition, the clinical signs and symptoms of infection were present and the patient reported significant levels of pain.  

Treatment
Moistened ACTICOAT 7 was applied to the wound and covered with ALLEVYN^◊ Dressing changes occurred every 7 days.  

Outcome
After 4 weeks, the wound had significantly reduced in size to only 0.8cm wide, 3.7cm long and 0.2cm deep. The patient was no longer experiencing pain and all signs of infection had disappeared (Fig. 2 and 3).

Fig 1	Fig 2
Fig 3

Cost Analysis

The patient had approximately 9 months of conventional treatment for his diabetic foot ulcer, with the ulcer remaining unhealed. After 4 weeks of using ACTICOAT 7 the ulcer had progressed well towards healing.

This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.

ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) in the management of a venous leg ulcer 

Introduction
This case study demonstrates the use of ACTICOAT 7 in the management of a venous leg ulcer in a patient with diabetes.  

Patient
The patient was a 71 year old male, treated at home for an ulcer located on the lower medial aspect of the leg. The ulcer had been present for two months. The ulcer had been previously dressed with a hydrocolloid dressing. At the beginning of treatment the wound measured 5cm x 9cm x 2mm. The wound was covered with 95% non-viable tissue and the surrounding skin was reddened and macerated. Exudate levels were small and no clinical signs of infection were detected (Fig.1).  

Treatment
The wound was cleansed and moistened ACTICOAT 7 was then applied. The ACTICOAT 7 was covered with moistened gauzes and dry gauzes on the top. Dressing changes were carried out every 7 days (Fig.2). Due to the diabetes and possibly an ischaemic component, compression therapy was not used.

Outcome
After two weeks the wound was completely free of non-viable tissue. After 4 weeks the wound was completely closed (Fig.3).

Fig 1	Fig 2	Fig 3

Use of ACTICOAT 7 (with SILCRYST^◊ Nanocrystals) on a pressure ulcer of the sacrum

Introduction
This case study illustrates the use of ACTICOAT 7 in the treatment of a pressure ulcer that had failed to respond to previous treatment.  

Patient
The patient was an 80 year old male with multiple lesions to the sacrum, which had been present for 3 months. The patient was malnourished with malignancy. The ulcer had been previously treated with hydrocolloids but without improvement. Prior to the use of ACTICOAT 7, the patient's wound measured 48cm ² (see Fig. 1).  

Treatment
ACTICOAT 7 was moistened, applied to the ulcer and covered with an ALLEVYN^◊ dressing. Dressing changes were carried out every 7 days.  

Outcome
After 7 days, the wound was reduced in size to 32cm². The condition of the wound dramatically improved, which is clearly evident in Figure 2.

Fig 1	FIg 2	Fig

Cost Analysis

The patient had approximately 3 months of conventional treatment for his grade 2 pressure ulcer, with the ulcer remaining unhealed. An 8-piece course of ACTICOAT 7 resulted in an ulcer that was reduced in size by 33% within 1 week, and completely closed within 8 weeks.

This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.