Advice

The technology

The technology

Granulox (Mölnlycke Health Care) is a topical sterile haemoglobin spray for treating chronic non-healing wounds, such as diabetic foot ulcers, venous leg ulcers and pressure ulcers. The company claims that the spray can transport oxygen to the base of non-healing wounds to support wound healing. It is sprayed onto the wound bed after debridement and before the relevant dressing is applied. The company claims that 1 canister of Granulox (12 ml) is sufficient for up to 30 applications, depending on the size of the wound.

Innovations

The company claims that Granulox is innovative over other oxygen therapies because it is designed to allow oxygen to diffuse through wound exudate, which could improve healing. It can be applied in various settings such as in the person's home, a GP surgery or hospital setting. Unlike other oxygen delivery technologies, Granulox does not need costly consumables, electrical power or full or partial body coverage in a chamber.

Current care pathway

Granulox is intended to be used alongside standard care for chronic non‑healing wounds. Wound care depends on the type of wound and can vary between centres. Standard care typically involves cleaning and dressing it.

Complex wounds, for example diabetic foot ulcers, venous leg ulcers and pressure ulcers, can result in chronic non-healing wounds and need more advanced care. For diabetic foot or venous leg ulcers, healthcare professionals record the depth and position of the ulcer and offload or apply compression therapy. The wound is cleansed and debrided regularly and dressed with the most appropriate dressing to manage exudate and promote wound healing. More advanced dressings, such as dermal or skin substitutes, may be needed alongside standard care for chronic non-healing wounds.

If a non-healing wound is thought to be infected, healthcare professionals typically take a microbiological sample and prescribe an antibiotic to treat the infection. People may be referred to a specialist for multidisciplinary care, depending on the cause of the wound. Tissue viability nurses generally assess wounds if they are seriously infected, if there is a differential diagnosis, or if the person has complex comorbidities.

The following publications have been identified as relevant to this care pathway:

Population, setting and intended user

Granulox is intended to be used alongside current treatment for people with chronic non-healing wounds that have not responded to standard care. The technology should not be used if a person is pregnant.

Granulox can be used in primary care, secondary care or in a community setting. It can be applied by different healthcare professionals, including tissue viability nurses, podiatrists, GPs and hospital-based clinicians, as well as people or their carers at home. Healthcare professionals and other people using the technology do not need specialised training before use.

Costs

Technology costs

Granulox costs £125 for up to 30 applications per canister, depending on the size of the wound. The company states that 1 canister is sufficient for up to 10 weeks of treatment based on 3 dressing changes per week. The cost of the technology is in addition to standard care, but the company claims that the technology improves healing outcomes and so reduces the resource burden of chronic non-healing wounds.

Costs of standard care

The company states that the costs for treating chronic non-healing wounds with standard care are:

  • 30 minutes of nursing time £18.50 (per dressing change)

  • primary dressing £3.13 (per dressing change)

  • secondary dressing £1.19 (per dressing change)

  • laboratory tests £7.00 (weekly)

  • antibiotics £3.04 (monthly)

  • analgesics £1.94 (monthly).

Chronic wound treatment is not a single treatment. It is a treatment process over time. Total wound care costs over a year are reported as £358 to £4,684 per person for a healed wound, and £831 to £7,886 per person for an unhealed wound (Guest et al. 2020).

Unit costs and 12‑month costs vary depending on the wound, the extent of the intervention and the costs of the local provider.

Resource consequences

The company states that the technology is used in at least 8 NHS Trusts.

Granulox is to be used alongside standard care and so costs more than standard care alone. The company claims that the technology could result in cost savings later because of a reduction in time to wound healing, a reduction in resource use for treating chronic non-healing wounds in community care, a reduction in resource use associated with healed wounds compared with open or infected wounds, a reduction in infected wounds, a reduction in secondary care admissions and a reduction in amputations. There is limited published evidence to support these claims.

Because the technology is used alongside standard care, organisational changes are unlikely to be needed. The company states that Granulox can be incorporated into existing care pathways by including it on local formularies.