Cost effectiveness analysis of larval therapy for leg ulcers

Marta O. Soares*, Cynthia P. Iglesias, J. Martin Bland, Nicky Cullum, Jo C. Dumville, E. Andrea Nelson, David J. Torgerson, Gill Worthy, VenUS II team

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

73 Citations (Scopus)
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To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers.

Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation.

Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue.

Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel.

Main outcome measure
The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis).

The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, £96.70 (€109.61; $140.57) more per participant per year (95% confidence interval −£491.9 to £685.8) than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval −0.95 to 31.91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval −0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at £8826 per QALY gained and £40 per ulcer-free day. Considerable uncertainty surrounds the outcome estimates.

Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel.

Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692.
Original languageEnglish
Article numberb825
Number of pages8
JournalBMJ (Online)
Publication statusPublished - 20 Mar 2009


  • larval therapy
  • leg ulcers
  • cost effectiveness analysis

ASJC Scopus subject areas

  • General Medicine


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