The technology

Advice

Innovations
Population, setting and intended user
Current care pathway
Costs
Resource consequences

The technology

LQD Spray (Brancaster Pharma) is a spray‑on primary wound dressing. It contains a modified biopolymer chitosan (chitosan FH02). The chitosan FH02 electrostatically interacts with cell surfaces and other biomolecules. The company states that the chitosan in LQD Spray comes from the shell of the Norwegian arctic sea shrimp, which is processed for medicinal use. The company claims it can replace the need for a secondary dressing in some patients, reduce pain and improve wound healing. This is because the properties of chitosan:

help to slow bleeding
enhance inflammatory cell function
promote formation of new blood vessels and connective tissue
are antimicrobial and antifungal
strengthen repaired tissue.

After cleaning or debriding the wound as needed, the company recommends that LQD Spray is sprayed over the wound from 10 cm away. It forms an active, chitosan-containing membrane over the wound within 2 minutes. The transparent, elastic film acts as a primary dressing and is a physical protection over the wound's surface. LQD Spray can be removed by cleaning the wound, or it is removed naturally through skin renewal. A secondary dressing and compression can be put over the wound after LQD Spray if clinically appropriate. For example, to manage low to moderate levels of exudate, to provide protection and padding to a burn wound, or in patients with chronic leg ulcers when compression bandaging is put over the wound after LQD Spray.

Innovations

LQD Spray is the only biopolymer wound dressing and it does not always need a secondary dressing. It is a natural antimicrobial which the company claims may reduce organism numbers of common wound pathogens, and it can be used in patient self-management. The company also states that it is innovative because it has a benefit at every stage of the wound healing process.

Population, setting and intended user

LQD Spray is for patients with acute wounds, including patients with self-harm wounds and chronic wounds. In patients with acute wounds, LQD Spray is for use instead of other primary wound dressing options. In patients with chronic wounds such as chronic leg ulcers, LQD Spray is for patients with wounds that are not healing with standard wound dressings such as foam dressings, super absorbers, alginate dressings and hydrofibre products. It is likely to be used in primary and secondary care. The company also claims that LQD Spray increases self-management, suggesting that it could be used by patients at home.

LQD Spray is likely to be used by tissue viability nurses, district nurses, podiatrists and patients themselves. The company states that no training is needed.

The company advises that LQD Spray is not appropriate for heavily exuding wounds, and heavy fibrin coatings and necrotic tissues must be debrided before treatment. LQD Spray is not fully effective if used with hydrogels or hydrocolloid dressings. The company states that there is no information available about LQD Spray use in pregnant women or nursing mothers. An additional caution outlined by the company is that LQD Spray may contain shellfish allergens. Inhalation and ingestion of LQD Spray should always be avoided. Special caution is recommended for any user who has a history of shellfish allergy, including those applying the treatment or in immediate vicinity of the spray.

Current care pathway

The current standard of care depends on aetiology. NICE's guideline on self-harm in over 8s recommends treating superficial uncomplicated injuries of 5 cm or less in length with tissue adhesive as first-line treatment. Skin closure strips may be offered if patients prefer. When treating superficial uncomplicated injuries of greater than 5 cm in length, or deeper injuries of any length, NICE recommends wound assessment and exploration, with a full discussion to decide the appropriate physical treatment. For patients who have a history of self-harm, NICE recommends that clinicians offer advice and instructions for the self-management of superficial injuries, including the provision of tissue adhesive.

For patients with diabetic foot ulcers, NICE's guideline on diabetic foot problems recommends 1 or more of the following treatment options: offloading, control of foot infection, control of ischaemia, wound debridement and wound dressings. NICE recommends that clinical assessment of the wound should be considered when deciding on wound dressings and offloading, as well as the person's preference. Devices and dressings with the lowest acquisition cost appropriate to the clinical circumstances should be used. NICE's medical technologies guidance on UrgoStart for treating diabetic foot ulcers and leg ulcers recommends interactive UrgoStart dressings to treat diabetic foot ulcers and venous leg ulcers when modifiable factors have been treated.

NICE's guideline on pressure ulcers recommends a wound dressing taking into account the patient's pain and tolerance, position of ulcer, amount of exudate and frequency of dressing change. For category 2, 3 and 4 pressure ulcers, a dressing should be considered that promotes a warm and moist wound healing environment. Gauze dressings are not recommended. Debridement may be needed depending on the amount of necrotic tissue, characteristics of ulcer, patient tolerance and comorbidities.

The Scottish Intercollegiate Guidelines Network's (SIGN's) management of chronic venous leg ulcers guideline recommends simple non-adherent dressings in addition to high-compression multicomponent bandaging for patients with chronic venous leg ulcers. Pentoxifylline may also improve healing for these patients.

Costs

Technology costs

LQD Spray has been listed in the NHS electronic drug tariff since May 2019. LQD Spray costs £45.00 (for 12 ml: 120 sprays per bottle). Costs per wound vary according to the indication and are summarised in table 1. All costs are company estimates. The costs assume no wastage of the spray. The costs of LQD Spray are as well as any secondary dressing that may be needed. The company states that after opening, LQD Spray can be stored upright at room temperature (15°C to 25°C) with its protective cap. It has a shelf life of 6 months after opening. The company says that, once open, the bottle can be used on multiple patients or multiple times for the same patient.

Table 1 Costs of LQD Spray according to indication

Description	Cost	Additional information
Acute wounds	£0.75 to £1.50 per application £1.50 to £4.50 per week £3.00 to £9.00 over 2 weeks	Average wound needs dressing 2 to 3 times per week, with 2 to 4 sprays per application. Company says average wound healed within 2 weeks.
Acute self‑harm wounds	£0.75 per application £2.25 per week	Average wound needs dressing 3 times per week, with 2 sprays per application. These cost estimates assume 1 small wound only. Patients with self-harm wounds may have multiple wounds, meaning costs may be higher.
Chronic wounds, for example, leg ulcers	£0.75 to £1.13 per application £3.75 per week £45 over 12 weeks	2 to 3 sprays per application.

Costs of standard care

A range of dressings can be used for acute and chronic wounds. Possible options are in table 2.

Table 2 Costs of standard wound dressings

Description	Cost per dressing	Additional information
Sterile, non-sterile and absorbent dressings	£0.07 to £2.60	Price depends on size and type. Source: NHS electronic drug tariff (August 2019).
Hydrogel dressings	£1.41 to £32.10	Price depends on size, type (gel versus ointment versus powder) and quantity. Source: NHS electronic drug tariff (August 2019).
Biocellulose dressings	£2.10 to £11.93	Price depends on size and type of biocellulose dressing. Source: NHS electronic drug tariff (August 2019).
Alginate dressings with superabsorbent backing	£1.77 to £9.15	Price depends on size and type of alginate dressing. Source: NHS electronic drug tariff (August 2019).
UrgoStart dressings	£4.28	Source: NICE medical technologies guidance on UrgoStart (accessed August 2019).

Resource consequences

The company states that LQD Spray is new to the NHS. The resource impact is in addition to standard care, but could be offset if there are greater benefits, such as no need for a secondary dressing and reduced nursing time.