Wound management presents financial and outcome challenges - Safety Matters

Healthcare Purchasing News, Sept, 2002 by Morris D. Kerstein

Wound care continues to be a major concern to healthcare providers. Whereas it might not be the most high-profile topic in the health section of local newspapers, its practical impact on the delivery of healthcare is real.

Common wounds, such as pressure and venous ulcers, affect up to 3.5 percent of the general patient population. Each case involving these and other common wounds costs at least hundreds, and often thousands, of dollars to treat--not including the costs of hospital stay, home healthcare or long-term care--for which the cumulative impact is a nationwide concern that totals many millions of dollars. This burden affects not only patients, payers and managed care organizations, but also providers and purchasing organizations if they are not knowledgeable of the most economically efficient means of treating wound cases.

Most materials managers and purchasing agents are keenly aware that wound management factors into the bottom line, Understanding the newest trends in managing wound care is a primary factor to those seeking ways to use improved technologies and supplies to improve patient outcomes and for those grappling with total cost.

Some treatment protocols, however, are better than others, The cost varies significantly, but only a few are truly cost effective. The difference between knowing which systems are more cost-effective in delivering the desired outcomes for the lowest costs can be quite significant.

According to current protocols and product sales, some of the "old standards" are currently being used, even though they cost providers more. Millions of dollars could be saved in wound care if the total treatment process were considered and better understood.

Three major issues influence total cost in wound management: patient outcomes (product efficacy), time and price. First, the better a treatment system works, the better the outcomes, Second, whereas the cliche "time heals all wounds" might not be entirely correct in this discussion, another Cliche is not--"time is money." For every day a wound goes unhealed, reciprocal costs involving care delivery, medications and other risk factors (such as infection) increase. Lastly, products and methods used to treat wounds have evolved significantly in recent years, and product price is not an accurate performance gauge.

The economics of wound care

A recent study, "Cost and Cost Effectiveness of Venous and Pressure Ulcer Protocols of Care," sheds light on the health economics of wound management in a manner that has not been accomplished previously.

The study involved several important steps, beginning with a comprehensive review of medical literature, meta-analysis and identifying widely accepted and implemented protocols of care. These protocols were reviewed by a panel of experts, including a vascular surgeon, a dermatologist, a family practitioner and a Ph.D. nurse practitioner who specializes in geriatrics. This panel sought consensus on current clinical practice and in doing so reviewed, validated and modified six protocols of care and two cost-effectiveness models to reflect clinical methods in the U.S.

Using these common protocols and models, the study organizers investigated the efficacy (including time) and total-cost variables of different treatments as they pertained to two of the most common types of ulcers, venous leg ulcers and pressure ulcers. More specifically, the measured drivers of cost were as follows: percentage of wounds healed completely in a defined period of time, mean time-to-healing using a specific protocol, mean wear time of wound dressings, and cost of managing complications. The primary independent variables were the wound types and types of dressings used.

The study used these models and results of the analyses to calculate cost of care for a patient population transposed to a hypothetical 100,000-member managed care organization.

Pressure ulcers

The study focused on pressure ulcers that occur among the general population at a rate of 3.5 percent. The three protocols of care for pressure ulcers were labeled protocol "G," which involved a saline gauze dressing, with debridement and other therapies; protocol "D," involving DuoDERM (E.R. Squibb & Sons, Princeton, NJ) with debridement, filler and the same other therapies; and protocol "C," including Comfeel (Coloplast, Humlebaek, Denmark) with debridement, filler and the same other therapies. The average size of the ulcers studied ranged between 2.5 and 5.6 [cm.sup.2], were of Stage II, III and IV, based on the Agency for Health Care Policy and Research (AHCPR--currently known as AHRQ Agency for Healthcare Research and Quality) guideline recommendations' definition of stage, and had an average duration of 9.6 weeks to 30.4 weeks.

The study determined that, with specific regard to pressure ulcers, the percentage of patients who showed complete healing within 12 weeks was 48 percent (1,267 patients) for protocol C (Comfeel), 51 percent (1,785 patients) for protocol C (gauze), and 61 percent (2,135 patients) for protocol D (DuoDERM). Those figures equated to a cost-per-patient healed of $2,179 for the gauze protocol, $1,267 for the Comfeel protocol and $910 for the DuoDERM protocol.