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        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Standard compression therapy for venous ulcers of the legs does not promote healing&#46; Although autografting accelerates tissue repair&#44; it is difficult to use in patients with concomitant diseases or when multiple grafts are required&#46; The amniotic membrane has been used as a covering material and promotes epithelialization&#44; making it a good potential treatment option when autografts are not indicated&#46;</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyze the literature on the safety and efficacy of amniotic membrane grafting and compare the cost of currently available grafts &#40;autografts&#44; amniotic membrane grafts&#44; and biocompatible skin substitutes&#41; to promote tissue repair in venous ulcers&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A systematic review of the literature on the use of amniotic membrane grafts for the treatment of venous ulcers was performed up to 2010&#46; A cost-minimization analysis of direct healthcare costs was then performed &#40;at 3 and 6 months&#41;&#46; A sensitivity analysis was performed to confirm the stability of the results&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Only 1 study addressing safety and efficacy was identified&#46; The cost-minimization analysis showed that autografts are always the least-expensive option &#40;&#8364; 1053 compared with &#8364; 1825 for amniotic membrane grafts and &#8364; 5767 for biocompatible skin grafts&#41;&#46; At 6 months&#44; however&#44; amniotic membrane grafts would have cost &#8364; 6765 less than the use of biocompatible skin substitutes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite having excellent therapeutic potential for the re-epithelialization of venous ulcers that do not respond to conventional treatment&#44; amniotic membrane transplant remains an experimental therapy&#46; Autograft is the most efficient treatment but amniotic membrane graft is less expensive than the use of biocompatible skin substitutes&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento est&#225;ndar compresivo de las &#250;lceras venosas de extremidades inferiores no promueve la cicatrizacion&#46; El autoinjerto es uno de los tratamientos que acelera la reparaci&#243;n tisular&#44; sin embargo&#44; su aplicaci&#243;n es dif&#237;cil en pacientes pluripatol&#243;gicos o cuando se requieren aplicaciones m&#250;ltiples&#46; La membrana amni&#243;tica se ha empleado como material de cobertura y como epitelizante&#44; por lo que podr&#237;a ser una buena opci&#243;n terap&#233;utica para cuando el autoinjerto no est&#233; indicado&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar el estado de conocimiento cient&#237;fico sobre la seguridad y la eficacia de la membrana amni&#243;tica y comparar los costes de los injertos disponibles actualmente &#40;autoinjertos&#44; membrana amni&#243;tica y sustitutos cut&#225;neos biocompatibles&#41; para promover la reparaci&#243;n tisular de las &#250;lceras venosas&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda y revisi&#243;n sistem&#225;tica de la literatura cient&#237;fica hasta marzo del 2010 sobre el uso de la membrana amni&#243;tica como tratamiento de las &#250;lceras venosas&#46; Asimismo&#44; se realiz&#243; un an&#225;lisis coste-minimizaci&#243;n &#40;horizonte temporal 3 y 6 meses&#41;&#46; Se consideraron los costes directos sanitarios&#46; Para comprobar la estabilidad de los resultados se llev&#243; a cabo un an&#225;lisis de sensibilidad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identific&#243; un &#250;nico estudio sobre seguridad y eficacia&#46; El an&#225;lisis de costes mostr&#243; que el autoinjerto es siempre la opci&#243;n m&#225;s barata &#40;1&#46;053 &#8364; versus 1&#46;825 &#8364; membrana amni&#243;tica&#44; 5&#46;767 &#8364; sustitutos cut&#225;neos biocompatibles&#41;&#46; A los 6 meses la membrana amni&#243;tica costar&#237;a 6&#46;765 &#8364; menos que el uso de los sustitutos cut&#225;neos biocompatibles&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El transplante de membrana amni&#243;tica para la reepitelizaci&#243;n de &#250;lceras venosas refractarias al tratamiento convencional es una opci&#243;n terap&#233;utica de gran potencial&#44; pero a&#250;n en estado experimental&#46; El autoinjerto es el tratamiento m&#225;s eficiente&#59; pero la membrana amni&#243;tica es m&#225;s econ&#243;mica que los sustitutos cut&#225;neos biocompatibles&#46;</p>"
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Journal Information
Vol. 102. Issue 4.
Pages 284-288 (May 2011)
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Vol. 102. Issue 4.
Pages 284-288 (May 2011)
Original article
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Cost-Benefit Analysis of Amniotic Membrane Transplantation for Venous Ulcers of the Legs That Are Refractory to Conventional Treatment
Estudio coste-beneficio del trasplante de membrana amniótica para úlceras venosas de extremidades inferiores refractarias a tratamiento convencional
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S. Gutiérrez-Morenoa, M. Alsina-Gibertb,
Corresponding author
malsina@clinic.ub.es

Corresponding author.
, L. Sampietro-Colomc, S. Pedregosa-Fausted, P. Ayala-Blancod
a Departamento Innovación y Evaluación, Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
b Servicio de Dermatología, Hospital Clínic, TSF, Universitat de Barcelona, Barcelona, Spain
c Dirección Innovación, Hospital Clínic, Barcelona, Spain
d Servicio de Dermatología, Hospital Clínic, Barcelona, Spain
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Abstract
Background

Standard compression therapy for venous ulcers of the legs does not promote healing. Although autografting accelerates tissue repair, it is difficult to use in patients with concomitant diseases or when multiple grafts are required. The amniotic membrane has been used as a covering material and promotes epithelialization, making it a good potential treatment option when autografts are not indicated.

Objectives

To analyze the literature on the safety and efficacy of amniotic membrane grafting and compare the cost of currently available grafts (autografts, amniotic membrane grafts, and biocompatible skin substitutes) to promote tissue repair in venous ulcers.

Material and methods

A systematic review of the literature on the use of amniotic membrane grafts for the treatment of venous ulcers was performed up to 2010. A cost-minimization analysis of direct healthcare costs was then performed (at 3 and 6 months). A sensitivity analysis was performed to confirm the stability of the results.

Results

Only 1 study addressing safety and efficacy was identified. The cost-minimization analysis showed that autografts are always the least-expensive option (€ 1053 compared with € 1825 for amniotic membrane grafts and € 5767 for biocompatible skin grafts). At 6 months, however, amniotic membrane grafts would have cost € 6765 less than the use of biocompatible skin substitutes.

Conclusions

Despite having excellent therapeutic potential for the re-epithelialization of venous ulcers that do not respond to conventional treatment, amniotic membrane transplant remains an experimental therapy. Autograft is the most efficient treatment but amniotic membrane graft is less expensive than the use of biocompatible skin substitutes.

Keywords:
Amniotic membrane
Cost-benefit analysis
Venous ulcern
Resumen
Introducción

El tratamiento estándar compresivo de las úlceras venosas de extremidades inferiores no promueve la cicatrizacion. El autoinjerto es uno de los tratamientos que acelera la reparación tisular, sin embargo, su aplicación es difícil en pacientes pluripatológicos o cuando se requieren aplicaciones múltiples. La membrana amniótica se ha empleado como material de cobertura y como epitelizante, por lo que podría ser una buena opción terapéutica para cuando el autoinjerto no esté indicado.

Objetivos

Analizar el estado de conocimiento científico sobre la seguridad y la eficacia de la membrana amniótica y comparar los costes de los injertos disponibles actualmente (autoinjertos, membrana amniótica y sustitutos cutáneos biocompatibles) para promover la reparación tisular de las úlceras venosas.

Material y métodos

Se realizó una búsqueda y revisión sistemática de la literatura científica hasta marzo del 2010 sobre el uso de la membrana amniótica como tratamiento de las úlceras venosas. Asimismo, se realizó un análisis coste-minimización (horizonte temporal 3 y 6 meses). Se consideraron los costes directos sanitarios. Para comprobar la estabilidad de los resultados se llevó a cabo un análisis de sensibilidad.

Resultados

Se identificó un único estudio sobre seguridad y eficacia. El análisis de costes mostró que el autoinjerto es siempre la opción más barata (1.053 € versus 1.825 € membrana amniótica, 5.767 € sustitutos cutáneos biocompatibles). A los 6 meses la membrana amniótica costaría 6.765 € menos que el uso de los sustitutos cutáneos biocompatibles.

Conclusiones

El transplante de membrana amniótica para la reepitelización de úlceras venosas refractarias al tratamiento convencional es una opción terapéutica de gran potencial, pero aún en estado experimental. El autoinjerto es el tratamiento más eficiente; pero la membrana amniótica es más económica que los sustitutos cutáneos biocompatibles.

Palabras clave:
Membrana amniótica
Coste-beneficio
Úlcera venosa
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References
[1.]
J.E. Jones, E.A. Nelson.
Skin grafting for venous leg ulcers.
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Amniotic membrane use in dermatology.
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Gris Castellón O. Transplante de membrana amniótica en patología de la superficie ocular Tesis Doctoral (ISBN: 84-688-7778-9). Barcelona: 2004 Universidad Autónoma de Barcelona; Available at: www.tdx.cat/TDX-1124104-170340/#documents
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Use of amniotic membrane transplantation in the treatment of venous ulcers.
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V. Falanga, D. Margolis, O. Álvarez, M. Auletta, F. Maggiacomo, M. Altman, et al.
Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent Human Skin Equivalent Investigators Group.
Arch Dermatol, 134 (1998), pp. 293-300
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Evaluation of the Cryopreserved Amniotic Membranes in the Care of Resistant Vascular Ulcers (MAUV). Phase II study. University Hospital, Limoges. Available at: www.ClinicalTrials. gov. Identifier: NCT00820274.
Copyright © 2011. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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