Cost-effectiveness of polyhexamethylene biguanide 0,1% and betaine 0,1% solution (Prontosan®) versus saline for cleansing of chronic wounds under the Brazilian Private Health System perspective

Abstract

Introduction: The presence of biofilms in chronic wounds is an important cause of delays in healing process, what makes the cleansing of these wounds beds a critical point for such problem management. In the industrialized world, there is almost 1 -1.5% of reported incidence of chronic wounds, representing significant costs for healthcare systems. Solutions based in the association of polyhexamethylene biguanide (polihexanide, PHMB) and betaine, due to its surfactant and preservative function, can better promote wounds beds preparation than the traditional saline, avoiding complications such as secondary infections that can enlarge healing times and treatment costs for these wounds. Objective: Evaluate cost-effectiveness of PHMB plus betaine solution (Prontosan®, B.Braun) for cleansing of chronic wounds from any etiology, compared to saline solution, under the scope of Brazilian private health system.. Method: Systematic review of literature, cost-effectiveness and budget impact analysis of PHMB plus betaine solution versus saline under the perspective of Brazilian Supplementary Health System for cleansing of chronic wounds. Results: In the basic scenario of the technology under assessment, incremental cost-effectiveness ratios have shown negative results, reflecting reduction of total treatment costs. Conclusion: Incorporation of Prontosan® Solution by the Supplementary Health System in Brazil, in the economic point of view, has shown to be feasible, specially when the comparison is dislocated from acquisition prices to treatment costs. Under the perspective of incremental cost-effectiveness, the use of Prontosan® Solution would constitute an important improvement for management of chronic wounds, with no need of investment from payers.