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Vacuum-assisted closure (V.A.C.) Therapy (KCI International, San Antonio, TX) has been widely used in hospital settings. However, use of V.A.C.) Therapy in home health settings outside of the United States of America (USA) is often limited because of financial considerations. This review paper considers the published evidence on V.A.C. Therapy in home health settings from the USA and beyond and explores the potential economic implications of V.A.C. Therapy in home health settings.
The aim of this study was to review the feasibility of using vacuum-assisted closure (V.A.C.) Therapy for the management of surgical and traumatic wounds in the home care settings in the Netherlands. De-identified patient data were collected from a health insurance database in the Netherlands. All patients with complete records, including indication, age, duration of therapy and defined treatment goal between January and November 2006 were included. Data from 338 patients were analysed. On average, wounds had been present for 2 months before start of V.A.C. Therapy. Overall, 74% of patients reached the pre-defined therapy goal (77% for dehisced wounds, 68% for abdominal wounds, 73% for traumatic wounds and 91% for sternal wounds) with approximately 1 month of V.A.C. Therapy. There was a negative association between the wound duration prior to V.A.C. Therapy and the treatment success rate (r = -0.162, P = 0.003). Wounds with shorter duration (6 months prior to V.A.C. Therapy. V.A.C. Therapy is a feasible and effective treatment for surgical and traumatic wounds in home care patients with over 70% of patients treated in this sample achieving pre-defined treatment goals. The success rate of V.A.C. Therapy is negatively associated with the duration of the wound before V.A.C. Therapy is commenced.
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OBJECTIVE: To estimate the yield from searching a range of bibliographic databases and additional sources to identify test accuracy studies for systematic reviews.
STUDY DEISGN AND SETTING: We examined eight systematic reviews and their database searches: MEDLINE, EMBASE, BIOSIS, Science Citation Index, LILACS, Pascal, and CENTRAL. We used studies included in each systematic review as the "gold standard," against which yield was estimated. For each database, we classified studies in each gold standard set as being (1) included in the database and identified by searches, (2) included and not identified, and (3) not included in the database.
RESULTS: No search identified all studies in any gold standard set. EMBASE, Science Citation Index, and BIOSIS contained studies that were not on MEDLINE. Over 20% of studies in the gold standard sets were not identified by searching MEDLINE. Six studies on LILACS were not on any other database. Eight gold standard studies were not included in any of the databases, and a further 22 were not identified by the electronic search strategies.
CONCLUSIONS: Systematic reviews of test accuracy studies should search a range of databases. Even searches designed to be very sensitive, that do not use study design filters, can fail to identify relevant studies.
OBJECTIVE: To determine the cost-effectiveness ofVacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US.
METHOD: A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed.
RESULTS The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings.
CONCLUSION: The model results indicate that VAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost ofVAC therapy and the utility weights applied to health states.
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