Evaluating the clinical and economic impact of ceramide-infused skin barriers in patients with Intestinal and urinary stomas: A systematic review and meta-analysis

Abstract

Purpose

Ceramide-infused skin barriers (CIBs) applied to stoma care hold potential benefits, which are thus far not summarized. This study aims to summarize the literature on CIBs in patients with intestinal and urinary stomas and to quantitatively compare the clinical, economic, and well-being outcomes of CIBs against the standard of care (SOC) in these patients.

Methods

Systematic review and random-effect meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including meta-regression analyses to explore sources of heterogeneity. PubMed, CINAHL, Scopus, Web of Science, Embase, Google Scholar, and clinicaltrials.gov were searched for studies published up to November 2024. Studies involving patients of any age with intestinal or urinary stomas treated with CIBs or SOC. Outcomes included peristomal skin complications (PSCs), cost-effectiveness, and quality-adjusted life days (QALDs).

Findings

CIBs increased the odds of preventing PSCs by 77% compared to SOC (OR = 1.77, 95% CI: 1.40, 2.23). Cost savings averaged -140,000 USD per patient (95% CI: -142,000 USD, -139,000 USD), although cost-effectiveness varied significantly (I² = 100%, P < 0.001). Meta-regression identified gross domestic product (GDP) per capita (β = -7.31, P = 0.010) and healthcare expenditure per capita (β = -169.33, P < 0.001) as key contributors to cost variability. CIBs also improved QALDs (MD = 0.35, 95% CI: 0.33, 0.37), enhancing patient quality of life.

Implications

CIBs reduce PSCs, generate cost savings, and improve QALDs, demonstrating potential for widespread clinical adoption. However, economic benefits vary across healthcare systems, warranting further research into their long-term impact and country-specific cost-effectiveness.