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Background. Diabetic foot ulcers are a common problem and result in more than 85,000 lower extremity amputations each year in the United States. Studies have suggested that between 25% and 50% of costs related to inpatient diabetes care may be directly attributable to the diabetic foot. Novel treatments for these wounds, while expensive, have been reported to improve healing rates, although no formal cost effectiveness analyses have been performed in order to address the cost effectiveness of a given therapy. Objective. To estimate the cost effectiveness of common treatment strategies for diabetic neuropathic foot ulcers. Methods. Four main options are available for the treatment of diabetic foot ulcers: (1) standard care (SC), (2) standard treatment in a specialized wound care center (WCC), (3) treatment with becaplermin, (4) or treatment with platelet releasate (PR). We utilized effectiveness data from published clinical trials, meta-analyses, and a database that includes data on 26,599 patients with these wounds. Effectiveness was assessed as a percentage of ulcers healed at 20 and 32 weeks. Results. Baseline effectiveness (with 95% confidence intervals) for SC, becaplermin, PR, and WCC care were 30.9% (26.6, 35.1), 43.0% (37.3, 48.7), 36.8% (35.4, 38.2), and 35.6% (34.8, 36.4), respectively. Cost:effectiveness ratios for PR versus SC and becaplermin versus SC were 414.40 and 36.59, respectively. Therefore the incremental cost of increasing the odds of healing by 1% over standard therapy was $414.40 for PR and $36.59 for becaplermin. Conclusions. PR, becaplermin, and WCC care all provided improved healing rates over standard care, and becaplermin was less expensive and more effective than PR after 20 weeks of care. [ABSTRACT FROM AUTHOR]

BACKGROUND. Agents reviewed for this manuscript were both rare and popular topical treatments for pressure ulcers. OBJECTIVE. To review topical treatments for pressure ulcers and evaluate them based on available literature of controlled, blinded, and randomized trials. METHODS. A MEDLARS database (1966-1993) search and a thorough review of reference article lists of key articles produced over 100 manuscripts. Studies were considered for review if they were conducted on humans with chronic stage II to IV pressure ulcers, in a properly controlled and randomized fashion. RESULTS. The use of zinc acetate and aluminum hydroxide ointment, phenytoin, recombinant platelet-derived growth factor-BB (rPDGF-BB), and basic fibroblast growth factor (bFGF) have been evaluated in a controlled and blinded fashion. Many of the newer agents, cytokine growth factor (eg, rPDGF-BB and bFGF) and skin equivalents, are currently being scrutinized in clinical trials. CONCLUSION. A paucity of data exist that adequately address the efficacy of any topical agent for the treatment of pressure ulcers. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about evaluating any relationship between lipid profiles, alopecia and coronary disease.