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Although chronic wounds have a high socio-economic impact, data on comparative effectiveness of treatments are rare. UrgoStart® is a hydroactive dressing containing a nano-oligosaccharide factor (NOSF). This study aimed at evaluating the cost-effectiveness of this NOSF-containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell® Contact) without NOSF.Cost-effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study ‘Challenge’ suggesting a response rate (≥40% wound size reduction) of UrgoStart® of 65·6% versus 39·4% for the comparator.In the treatment model, effect-adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart® versus €1335·51 for the comparator resulting in an effect-adjusted cost advantage of €485·64 for UrgoStart®. In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates.In an 8-week period of treatment for vascular leg ulcers, UrgoStart® shows superior cost-effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double-blind clinical trial, UrgoStart® is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow-up data of 12 months to allow for reulceration assessment were not generated.