Cost-effectiveness of adjunct haemoglobin spray in the treatment of hard-to-heal wounds in a UK NHS primary care setting.

OBJECTIVE: To evaluate the cost-effectiveness of topical haemoglobin spray as adjunct therapy in the treatment of hard-to-heal wounds within a UK National Health Service (NHS) community setting. METHOD: In a previously published comparative clinical evaluation, 50 consecutive patients treated with topical haemoglobin spray, as adjunct to standard care and followed up over 26 weeks, were compared with 50 consecutive retrospective controls from the same clinic treated with the same standard care protocol in the year prior to the introduction of adjunct topical haemoglobin spray. A de novo cost-effectiveness and break-even analysis were performed, using data from the previously published clinical evaluation, for all patients (intent-to-treat) and for patients with complete follow-up using a micro-costing approach and considering only wound care dressing costs. RESULTS: At 26 weeks, the total cost of dressings for all patients in the intervention group was £6953 with 874 cumulative weeks healed, compared with £9547 with 278 cumulative weeks healed for all patients in the control group. The incremental cost-effectiveness ratio (ICER), the incremental cost per additional week healed with adjunct topical haemoglobin spray, is therefore negative (dominant). Total treatment costs per week were lower from week six onwards, with break-even estimated to be at week 10.2. When considering only patients with complete follow-up, the results were similarly dominant, with a mean 10.9 more weeks healed, a mean dressing cost saving per patient of £81.83 by week 26 (-37%). Cost savings were realised from week five, and a break-even was estimated to occur at week 8.0. CONCLUSION: Topical haemoglobin spray has the potential to restore the healing process, reduce healing times and reduce dressing costs in a NHS community setting, within a few weeks of adoption.

Evaluation of microtitre plate-based Haemoglobin estimation.

INTRODUCTION: Haemoglobin estimation is one of the most important clinical investigations. Many techniques are available to measure haemoglobin; still there is a need for a haemoglobin assay technique which is cheap, robust and simple and can be used in field conditions very quickly using figure prick sample. We evaluated a cyanmethaemoglobin-based haemoglobin estimation using a microtitre plates for the purpose. METHODS: Microtitre plate-based haemoglobin estimation was developed using cyanmethaemoglobin-based assay and was compared with standard haematology analyser-based haemoglobin estimation in a large number of samples from a population of voluntary blood donors. Various tests were performed to evaluate the stability of colour, variation of the results during duplicate assay on the same days and on different days as well as linearity of the test was performed against broad range of haemoglobin values for the new microtitre plate-based technique. Standard statistical test of significance was applied to validate the assay. RESULTS: Total 200 samples from in-house and field conditions were evaluated. 10 µL blood sample in 300 µL Drabkin's solution provided optimum and comparable results after 10 minutes of incubation. The colour was stable up to 6 hours, the coefficient of variation was less than 3%, and the cost per test including everything was less than 3 cent/2P. Turnaround time for 90 samples was only 30 minutes. CONCLUSION: Cyanmethaemoglobin-based assay in microtitre plate is feasible, robust, rapid, cheap and cost-effective method for haemoglobin estimation in field conditions.

Enhancing stability and expression of recombinant human hemoglobin in E. coli: Progress in the development of a recombinant HBOC source.

The commercial feasibility of recombinant human Hb (rHb) as an O(2) delivery pharmaceutical is limited by the production yield of holoprotein in E. coli. Currently the production of rHb is not cost effective for use as a source in the development of third and fourth generation Hb-based oxygen carriers (HBOCs). The major problems appear to be aggregation and degradation of apoglobin at the nominal expression temperatures, 28-37 degrees C, and the limited amount of free heme that is available for holohemoglobin assembly. One approach to solve the first problem is to inhibit apoglobin precipitation by a comparative mutagenesis strategy to improve apoglobin stability. alpha Gly15 to Ala and beta Gly16 to Ala mutations have been constructed to increase the stability of the alpha helices of both subunits of HbA, based on comparison with the sequences of the more stable sperm whale hemoglobin subunits. Fetal hemoglobin is also known to be more stable than human HbA, and sequence comparisons between human beta and gamma (fetal Hb) chains indicate several substitutions that stabilize the alpha1beta1 interface, one of which, beta His116 to Ile, increases resistance to denaturation and enhances expression in E. coli. These favorable effects of enhanced globin stability can be augmented by co-expression of bacterial membrane heme transport systems to increase the rate and extent of heme uptake through the bacterial cell membranes. The combination of increased apoglobin stability and active heme transport appear to enhance holohemoglobin production to levels that may make rHb a plausible starting material for all extracellular Hb-based oxygen carriers.

Oxygen carriers ("blood substitutes").

(1) A number of oxygen carriers, or "blood substitutes", are undergoing clinical trials. One product (Hemopure(R)) was recently licensed for use in South Africa. Another, (Hemolink(tm) may soon be approved for marketing in Canada. (2) Most trials of oxygen carriers have focused on their use in surgery, primarily as a way to minimize the need for allogeneic blood transfusion. (3) The benefits of these products in comparison with other blood conservation technologies and with allogeneic blood transfusion must be determined. (4) The safety and cost-effectiveness of these products, and the patient populations that would benefit most from their use require further study.

Uso de hierro intravenoso en pacientes renales crónicos con anemia. Mayores niveles de hemoglobina a más bajo costo / Use of intravenous iron in chronic renal patients with anemia. Higher levels of hemoglobin at a lower cost

It is presented the experience with 90 patients receiving Eritropoietin s.c. and oral iron who were in chronic haemodialysis. After basic laboratories, including iron kinetic, in all of them was stopped oral iron and started i.v. iron 60 mgs per week, but keeping the same eritropoietin doses. The results showed an increased haemoglobin level from 6.5 to 11 g/dl mean values and a decreased doses of eritropoietin between 25 to 50%. This represent an important elevation of haemoglobin levels at a significant low cost

[Use of intravenous iron in chronic renal patients with anemia. Higher levels of hemoglobin at a lower cost]. / Uso de hierro intravenoso en pacientes renales crónicos con anemia. Mayores niveles de hemoglobina a más bajo costo.

It is presented the experience with 90 patients receiving Eritropoietin s.c. and oral iron who were in chronic haemodialysis. After basic laboratories, including iron kinetic, in all of them was stopped oral iron and started i.v. iron 60 mgs per week, but keeping the same eritropoietin doses. The results showed an increased haemoglobin level from 6.5 to 11 g/dl mean values and a decreased doses of eritropoietin between 25 to 50%. This represent an important elevation of haemoglobin levels at a significant low cost.

[Expression of recombinant human hemoglobin in plants]. / Expression d'hémoglobine humaine recombinante dans les plantes.

Human utilization of recombinant proteins of therapeutical interest, as hemoglobin, implies that the transgenic host allows a low cost production of the active proteins with minimal risks of pathogen contamination. In this regard, the use of transgenic plants could be of great interest. In particular, the systems based on plants could be one of the most economical transgenic system, compared with the others, because biomass obtention in fields is not expensive.