HTA Report 12: Topical negative pressure therapy for
wounds
About this report
Topical negative pressure (TNP) is a widely
diffused treatment for acute, chronic and surgical wounds. It
comprises a sealed dressing over a wound, a suction pump and a
drainage tube going from inside the dressing or its surface to a
canister within the pump unit. There is uncertainty around the
effectiveness of TNP. NHS boards vary in the applications for which
TNP is used.
In light of the perceived high cost of the
technology, and uncertainty around its effectiveness and variation
in practice, the Scottish Health Technologies Group (SHTG)
commissioned a health technology assessment (HTA) to inform
national decision making. The objectives of the HTA were to:
1. assess the clinical and
cost-effectiveness evidence for the use of TNP to support
evidence-based decision making and reduce variation in
clinical practice
2. highlight patients
experience of TNP
3. address difficulties of
infrastructure and service delivery.
Results and conclusions
While the evidence base for this technology is
extremely weak, the HTA has identified areas of application in
which TNP may improve clinical outcomes. Cost- effectiveness
evidence is limited and not necessarily generalisable to Scotland.
Primary research has raised issues of importance to patients and
suggests that patients¿ experiences of TNP are generally
favourable.
The clinical effectiveness conclusions for TNP
are as follows:
1. for chronic wounds, there is some evidence
of clinical benefit of TNP for pressure ulcers of grades III and
IV, diabetic foot wounds (including post-amputation) and venous leg
ulcers receiving a split-thickness pinch skin graft. No comparative
evidence was found for pilonidal sinus or venous leg ulcers not
being grafted.
2. for acute wounds, there is some evidence
of clinical benefit of TNP for trauma and burns receiving skin
graft. No conclusions could be drawn for necrotising fasciitis or
burns not being grafted.
3. for surgical wounds, there is some
evidence of benefit in open abdominal wounds with peritonitis, and
open chest wounds.
A US study finding that V.A.C.® was
cost effective for diabetic foot ulcers compared with traditional
or advanced dressings formed the sole evidence on cost
effectiveness of TNP. This finding should be treated with caution
as it may not generalise to a Scottish setting because of
differences in the patient population, healthcare system and costs.
Additionally, there was uncertainty around the quality of studies
from which clinical effectiveness estimates were derived.
There was no cost-effectiveness evidence for
TNP on any other application or for any other manufacturer's
device.
Implications for NHS
boards
No recommendation can be made regarding
increasing, decreasing, or maintaining similar provision of TNP in
NHSScotland. Decisions on resource allocation need to continue to
be made in the context of competing demands and incomplete
information. Clinicians should continue to select treatment
modalities on the basis of individual patient need, supported by
the multidisciplinary care team, within the budgetary constraints
of their setting. For most types of wound, TNP is one option among
many, and may be used before or after other therapies are
tried.
Understanding our Advice
A summary booklet will be produced for people
who do not have specialist knowledge in this area. It will explain
what topical negative pressure is, the conditions that it can be
used to treat and the evidence which we looked at.
Further information
For further information on this project or the
work of SHTG contact:
Doreen.Pedlar@nhs.net
Project Co-ordinator
0141 225 6998
or visit the SHTG webpages http://shtg.nhshealthquality.org
Published Date: 01 August 2010
