HTA Report 12: Topical negative pressure therapy for wounds (PDF, 698K, 54secs)
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
Understanding our Advice (PDF, 207K, 25secs)
Equality & Diversity
NHS QIS is committed to equality and diversity. This document has been assessed for any likely impact on the six equality groups defined by age, gender, race/ethnicity, religion/faith, disability and sexual orientation and the cross cutting strands defined as poverty, homelessness, language and social origin, criminal justice system, mental health issues and marital including civil partnership. Details of the equality and diversity impact assessments are available here
Further information
For further information on this project or the work of SHTG contact:
Project Co-ordinator
0141 225 6998
or visit the SHTG webpages http://shtg.nhshealthquality.org
