Cost and Cost Effectiveness of Venous and Pressure Ulcer Protocols of Care
Morris D. Kerstein
Lia van Rijswijk
Courtney H. Lyder
Background: To meet the challenge of an aging population, providers and payors must optimize chronic wound care outcomes and contain costs. Objective: To explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols. Design: Modeling study using outcomes from a literature review. Methods: The cost of 12 weeks of wound care was modeled for a hypothetical managed-care plan. This included 100 000 covered lives and used a peer-validated wound care protocol. Only modalities with a pooled evidence base of at least 100 wounds were used to populate the model. Costs excluded supportive treatments. Results: 26 studies of three pressure ulcer protocols (n = 519) and three venous ulcer protocols (n = 883) qualified for inclusion in the models. After 12 weeks, the weighted average proportion of ulcers healed, and cost per ulcer healed, ranged from 48 to 61% and from $US910 to $US2179 (2000 values) for pressure ulcers, and from 39 to 51% and $US1873 to $US15 053 for venous ulcers. For a hypothetical managed-care plan, the difference between the least and most cost-effective modalities was $US1.9 million for pressure ulcers and $US5.8 million for venous ulcers. Observed differences were generally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpatient care settings; venous ulcers are managed on an outpatient basis. Physician visit frequencies are once every four weeks for pressure ulcers and once each week for venous ulcers. Wound sizes ranged from 2.5cm2 to 5.6cm2 for pressure ulcers and 5.4cm2 to 10cm2 for venous ulcers. All patients with pressure ulcers required pressure relief, nutritional support and incontinence management; venous ulcers required gradient compression. Costs per patient healed were lowest for pressure ulcers with hydrocolloids and highest with saline gauze (this is a manpower issue). Costs to heal venous ulcers were highest with human skin construct and lowest for 12-week management with hydrocolloid. Conclusions: Despite the limitations of the models (as a result of incomplete study data), this analysis confirms that defining wound care costs solely as cost of products used is inaccurate and can be expensive.
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