Health economic burden that different wound types impose on the UK's National Health Service.
TL;DR: Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (a) wound prevention, (b) accurate diagnosis and (c) improving wound‐healing rates.
Abstract: The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to the management of different wound types by the UK's National Health Service (NHS) in 2012/2013 and the annual costs incurred by the NHS in managing them. This was a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and all health care resource use were quantified, and the total NHS cost of patient management was estimated at 2013/2014 prices. The NHS managed an estimated 2·2 million patients with a wound during 2012/2013. Patients were predominantly managed in the community by general practitioners (GPs) and nurses. The annual NHS cost varied between £1·94 billion for managing 731 000 leg ulcers and £89·6 million for managing 87 000 burns, and associated comorbidities. Sixty-one percent of all wounds were shown to heal in an average year. Resource use associated with managing the unhealed wounds was substantially greater than that of managing the healed wounds (e.g. 20% more practice nurse visits, 104% more community nurse visits). Consequently, the annual cost of managing wounds that healed in the study period was estimated to be £2·1 billion compared with £3·2 billion for the 39% of wounds that did not heal within the study year. Within the study period, the cost per healed wound ranged from £698 to £3998 per patient and that of an unhealed wound ranged from £1719 to £5976 per patient. Hence, the patient care cost of an unhealed wound was a mean 135% more than that of a healed wound. Real-world evidence highlights the substantial burden that wounds impose on the NHS in an average year. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (a) wound prevention, (b) accurate diagnosis and (c) improving wound-healing rates.
Citations
More filters
TL;DR: A systematic review of chronic wounds revealed that health‐related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound‐related amputations.
Abstract: Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard-to-heal, or having led to an amputation. The review excluded studies that did not present data on generic health-related quality of life and/or cost data, case studies, randomized controlled trials, economic modeling studies, abstracts, and editorials. Extracted data were summarized into a narrative synthesis, and for a few articles using the same health-related quality of life instrument, average estimates with 95% confidence intervals were calculated. Thirty articles met the inclusion criteria. Findings revealed that health-related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound-related amputations. The cost burden was mainly attributed to amputations for patients also comorbid with diabetes, where the cost for hospitalization ranged from US$12,851 to US$16,267 (median) for this patient group. Patients with chronic wounds have poor health-related quality of life in general and wound-related costs are substantial. Development and implementation of wound management strategies that focus on increasing health-related quality of life and effectively reduce costs for this patient group are urgently needed.
325 citations
Cites background from "Health economic burden that differe..."
...1 billion in 2012.(9) In the United States, it has been reported that over 6....
[...]
TL;DR: The clinical needs and challenges associated with treatment of acute and chronic infections and the drivers for phage encapsulation are looked at, as well as looking at promising new approaches for micro- and nanoencapsulation of phage and how these may address gaps in the field.
296 citations
TL;DR: The findings showed that the vast majority of chronic wounds in epidemiological studies are made up by chronic leg ulcers, which is aligned to previous studies reporting point prevalence of chronic injuries identified within the healthcare system.
270 citations
TL;DR: This review aims at providing the reader with an overview of the most recent progress in silver nanotechnology, with a special focus on the role of silver in the wound healing process.
Abstract: Recent data have reported that the burden of infections related to antibiotic-resistant bacteria in the European Union and European Economic Area (EEA) can be estimated as the cumulative burden of tuberculosis, influenza, and human immunodeficiency virus (HIV). In wound management, the control of infections represents a crucial issue and a multi-billion dollar industry worldwide. For diabetic wounds ulcers, in particular, infections are related to the majority of amputations in diabetic patients, which today represent an increasing number of the elderly. The greatest barrier to healing is represented by the biofilm, an organized consortium of bacteria encapsulated in a self-produced extracellular polymeric substance with high resistance to conventional antimicrobial therapies. There is an urgent need for novel anti-biofilm strategies and novel antimicrobial agents and, in this scenario, silver nanotechnology has received tremendous attention in recent years in therapeutically enhanced healthcare. Due to its intrinsic therapeutic properties and the broad-spectrum antimicrobial efficacy, silver nanoparticles have opened new horizons towards novel approaches in the control of infections in wound healing. This review aims at providing the reader with an overview of the most recent progress in silver nanotechnology, with a special focus on the role of silver in the wound healing process.
226 citations
Cites background from "Health economic burden that differe..."
...During this period, the cost per unhealed wound ranged from £1719 to £5976 per patient, 135% more than that of a healed wound [18]....
[...]
TL;DR: To estimate the healthcare costs of diabetic foot disease in England, the number of patients diagnosed with diabetes and the severity of the disease is estimated to be between £20,000 and £30,000 a year.
Abstract: Aim To estimate the healthcare costs of diabetic foot disease in England. Methods Patient-level data sets at a national and local level, and evidence from clinical studies, were used to estimate the annual cost of health care for foot ulceration and amputation in people with diabetes in England in 2014-2015. Results The cost of health care for ulceration and amputation in diabetes in 2014-2015 is estimated at between £837 million and £962 million; 0.8% to 0.9% of the National Health Service (NHS) budget for England. More than 90% of expenditure was related to ulceration, and 60% was for care in community, outpatient and primary settings. For inpatients, multiple regression analysis suggested that ulceration was associated with a length of stay 8.04 days longer (95% confidence interval 7.65 to 8.42) than that for diabetes admissions without ulceration. Conclusions Diabetic foot care accounts for a substantial proportion of healthcare expenditure in England, more than the combined cost of breast, prostate and lung cancers. Much of this expenditure arises through prolonged and severe ulceration. If the NHS were to reduce the prevalence of diabetic foot ulcers in England by one-third, the gross annual saving would be more than £250 million. Diabetic foot ulceration is a large and growing problem globally, and it is likely that there is potential to improve outcomes and reduce expenditure in many countries.
201 citations
References
More filters
01 Jan 2014
TL;DR: The 2014 edition of the PSSRU Unit-Costs series as mentioned in this paper is the latest volume in a well-established series bringing together information from a variety of sources to estimate national unit costs for a wide range of health and social care services.
Abstract: This is the latest updated volume in a well-established series bringing together information from a variety of sources to estimate national unit costs for a wide range of health and social care services. This report consists of tables for more than 130 types of service which, as well as providing the most detailed and comprehensive information possible, also quotes sources and assumptions so users can adapt the information for their own purposes. This year we have included a guest editorial on ‘Big Data’: increasing productivity while reducing costs in health and social care and three short articles on The cost of integrated care; Shared lives – improving understanding of the costs of family-based support and the costs of providing a group intervention to people with dementia and their family carers:SHIELD: RYCT & CSP intervention costs (Remembering Yesterday Caring Today and Carer Support Programme). There are also several new schema providing the costs of: advocacy for people with learning disabilities; a hospice rapid response service; the early years classroom management programme; residential parenting assessments; independent review officers; time banks; dentists and care home costs for people with dementia. The 2014 edition is also available in full, free of charge, at the PSSRU website www.pssru.ac.uk/unit-costs/2014/ as an Acrobat file.
1,875 citations
TL;DR: To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a significant threat to healthcare providers in the UK, as it is in the USA.
Abstract: Objective: to estimate the annual cost of treating pressure ulcers in the UK. Design: costs were derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reXecting good clinical practice. Setting: health and social care system in the UK. Subjects: patients developing a pressure ulcer. Methods: a bottom-up costing approach is used to estimate treatment cost per episode of care and per patient for ulcers of different grades and level of complications. Also, total treatment cost to the health and social care system in the UK. Results: the cost of treating a pressure ulcer varies from £1,064 (Grade 1) to £10,551 (Grade 4). Costs increase with ulcer grade because the time to heal is longer and because the incidence of complications is higher in more severe cases. The total cost in the UK is £1.4–£2.1 billion annually (4% of total NHS expenditure). Most of this cost is nurse time. Conclusions: pressure ulcers represent a very signiWcant cost burden in the UK. Without concerted effort this cost is likely to increase in the future as the population ages. To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a signiWcant threat to healthcare providers in the UK, as it is in the USA.
705 citations
TL;DR: Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity (£5.0 billion), and clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.
Abstract: Objective To estimate the prevalence of wounds managed by the UK9s National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. Methods This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients’ characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. Results Patients’ mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p Conclusions Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK9s NHS, comparable to that of managing obesity (£5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.
473 citations
"Health economic burden that differe..." refers background or methods in this paper
...*The cost of (1) ambulance services and (2) accident and emergency attendances are not shown but included in the total....
[...]
...The annual cost to the NHS attributable to wound management and associated comorbidities was estimated at £5⋅3 billion (1)....
[...]
...We have already reported the prevalence of each wound type (1)....
[...]
...After adjustment for comorbidities, the annual NHS cost of managing wounds was estimated to be £4⋅5–5⋅1 billion, two-thirds of which was incurred in the community and the rest in secondary care (1)....
[...]
...This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) database, as previously described (1)....
[...]
Journal Article•
TL;DR: The costs of chronic wound management and the impact on patients and the healthcare system are discussed.
Abstract: This article discusses the costs of chronic wound management and the impact on patients and the healthcare system.
330 citations
"Health economic burden that differe..." refers background in this paper
...In addition, the annual NHS cost of managing pressure ulcers was estimated to be £1⋅8–2⋅6 billion (16)....
[...]
...One such study estimated the annual NHS cost of treating patients with venous ulceration to be £168–198 million and £300 million for diabetic foot ulcers (16)....
[...]
23 Oct 2014
191 citations
"Health economic burden that differe..." refers background in this paper
...The NHS Five-Year Forward View (5YFV) (15) identified a national need for a different integrated model of health and social care, which is ‘joined up’ and which addresses the needs of patients with long-term illnesses....
[...]