Specialist commentator comments
Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
There were 2 out of 4 specialists who were familiar with or had used this technology before.
Three of the commentators considered InterDry an innovation while 1 commentator considered it a minor variation to be used with current treatment for selected cases of intertrigo. None of the commentators were aware of any competing technologies indicated for the treatment of intertrigo that have a similar mode of action to InterDry. One commentator noted that there are several other silver-based dressings available, although they are not specifically indicated for intertrigo.
Potential patient benefits identified by commentators included the relief of itch, discomfort and odour, a reduction in maceration and moisture lesions, a reduction in the need for topical treatment and in the risk of secondary bacterial infection, as well as the ease of application and the ability to self-treat without needing sterile items or equipment. One commentator noted that the technology would be useful in people with severe chronic ulcerated intertrigo when standard first- and second-line treatments have failed to resolve symptoms. People with intertrigo who have a high body mass index, diabetes, are bed-bound or have limited mobility, have a prosthetic limb, and those with issues of excessive moisture were also identified by commentators as people who would benefit most from treatment with InterDry. Three of the commentators said that the technology has the potential to change the current care pathway by improving clinical outcomes compared with current treatment, and if it was able to prevent relapses and reduce the number of hospital visits. One of the commentators said that there would be fewer visits needed and patients could self-treat in the long term. Another commentator felt that the technology had the potential to simplify the nursing care for affected patients who were immobile or had obesity but would have little impact on the number of hospital visits for simple intertrigo cases.
Potential system benefits identified by commentators included a reduction in the use of topical treatments such as antifungal and steroid creams, a decrease in the nursing time needed and reduced healing time for chronic severe intertrigo. One commentator thought that the technology would be more cost effective than current treatment. One commentator said that InterDry would cost more than current treatment but thought that costs could be minimised if used in selected patients with chronic difficult-to-treat intertrigo. Another commentator said the possible cost savings would depend on the frequency of dressing changes. The remaining commentator noted that it was difficult to estimate the cost of current treatment, adding that there is no standard approach to treating intertrigo in the UK. One commentator did not predict a substantial impact on resource from adopting the technology. Another commentator thought it may lead to reduced healthcare visits in the long term because patients would be able to self-manage future incidences by preventing them from happening or treating them at an earlier stage. One commentator thought that the technology could help shift the ongoing management of previous difficult maceration from secondary to primary care, as well as reduce the risk of infection and the need for antibiotics and systemic antifungals. One commentator said that staff training may be needed on how to apply the dressing, as well as how to recognise potential complications of dressings such as contact allergy or irritation. Two of the commentators thought the technology could replace current practice while 2 commentators thought it would be used as well as current treatment options. None of the commentators was aware of any safety concerns about the technology.
Two commentators thought that the cost of the dressings may prevent the technology from being adopted in the NHS, while the remaining 2 commentators were not aware of any issues that would affect adoption. Securing the dressing, the size of the dressing, possible contact allergy and irritation, as well as areas of intertrigo that could make application of dressings more challenging (such as groin and perianal skin) were identified as potential issues with usability or practical aspects. Most of the commentators highlighted the difficulty in estimating the number of patients for whom InterDry would be suitable. One commentator noted that most patients have mild intertrigo and will manage their condition with simple self-treatment, and the incidence of intertrigo is unclear. Non-sponsored randomised controlled trials, studies with longer follow up, comparative evidence showing superiority over other currently used treatment options, evidence showing the antimicrobial action of its active agents against the microbes that are present on the areas of the skin with intertrigo and data showing the incidence of adverse reactions from use of the product were identified by the commentators as areas of further research needed to address uncertainties in the evidence base. One felt that dressings would be changed more frequently than every 5 days, adding that they would be reluctant to reapply a used dressing after bathing.