Jwc ewma final indd

Table4.Resourceutilisationanddebridement

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J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3  

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Timetohealing

A key theme in most studies are high costs 

associated with extended time to healing for  

hard-to-heal wounds. Most commonly, the 

size and duration of ulcer have been related 

to outcome

146,147

 and increased resource 

utilisation.

148,149

 A study by Tennvall et al.

148

 

confirmed that leg ulcers with an area of ≥ 10cm

2

 

and of longer duration (≥ 6 months) are the  

most expensive. The cost, for example, of 

treatment for a venous leg ulcer of less then 

6 months in Sweden was estimated as €1827 

(EUR) compared with €2585 for an ulcer of  

greater then 6 months’ duration.

148

Additionalcostsrelatedtohospitaland

homecaresetting

Many health-economic studies in non-healing 

wounds have focused on reduction in hospital stay 

and treatment at hospital based specialist clinics. 

However, a substantial number of resources are used 

in outpatient facilities in primary care/home care. 

When analysed according to care setting, home 

health care accounted for the largest proportion 

(48%) of the total cost of treating venous leg 

ulcers in the USA.

141

 A study in the UK calculated 

that, in 2000, the mean annual cost per patient 

for treatment at a leg ulcer clinic was €1205 and 

by community nurses was €2135.

150

 The finding 

that home health care accounts for a significant 

proportion of the total medical costs suggests that 

promotion of high-quality care based in outpatient 

clinics appears likely to improve cost efficiency. This 

can be illustrated by a Swedish study in primary 

care, where a system for early diagnosis of lower 

leg ulcers and a strategy to reduce frequency of 

dressings changes resulted in a substantial reduction 

in resources used and economic cost.

148,151

These studies suggest the importance of organisation 

in wound care, as well as coordination of treatment 

strategies, to achieve an optimal care, both with 

regard to outcome and cost.

the health economy  

of debridement

Debridement is considered an essential part of 

wound management, but the evidence supporting 

debridement as a primary treatment regimen to 

improve healing is sparse. The evidence primarily 

consists of self reporting from treating physicians 

and post hoc analysis of RCTs. As a consequence, 

the health economic data specifically related to 

debridement techniques are limited.

The literature listed in Table 5 covers the 

identified studies including a cost-effectiveness 

analysis of selected debridement techniques.

Need for studies on the cost-

effectiveness of debridement

Evidence, including health economic data, will 

become increasingly important in a situation 

where the impact of non-healing wounds on 

society, as well as on the individual, is clarified and 

the resources of the health-care system are scarce. 

For approval of new treatment strategies these data 

may become mandatory in many countries.

However, differences in reimbursement 

procedures, health-care organisation, salaries 

of staff members and facilities available in the 

various European countries, make it difficult to 

define clear-cut recommendations with regard to 

health economics. Furthermore, methodological 

difficulties, which are seen in the existing studies, 

demonstrate a need to increase the knowledge 

about economic evaluation with wound 

management in general. An overview of the 

methods of economic evaluation is included in 

the EWMA Document Outcomes in controlled and 

comparative studies on non-healing wounds.

149

 For a 

more complete discussion of economic evaluation 

in health care see Drummond et al.

152

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