Jwc ewma final indd

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

of hospital stay and time to healing.

135

 In a 

prospective study following diabetic patients 

with foot ulcers until healing, with or without 

amputation,

136,137

 the highest costs were for 

inpatient care and topical treatment of wounds. 

The costs for antimicrobial drugs, outpatient visits 

and orthopaedic appliances were low in relation to 

the total costs in both categories of patients. In the 

same study, the total cost for healing a foot ulcer 

was strongly related to the severity of the lesion 

and comorbidities.

137

When assessing use of resources, it is important not 

to focus on individual items, such as dressings or 

procedures, but to adopt a broader view of the total 

resource use.

138,139

 Table 4 provides an overview of 

the resource consumption related to debridement.

Additional costs may be related to rehabilitation, 

transportation, home care and social services, loss 

of productivity and reimbursement, depending on 

whether you apply a societal or a private payer’s 

perspective.

cost of wound management:  

Existing evidence 

As a very limited amount of data exist for the cost 

effectiveness of debridement, the results from 

studies of the costs of non-healing wounds may 

inform cost structures related to debridement.

Totalcostofinterventions

Product costs are often considered to be 

synonymous with the cost of care;

140

 however, 

the purchase price of, for example, dressings, 

rarely forms a significant portion of the actual 

cost of care.

141,142

 These dressing costs are often 

negligible in comparison with other factors, such 

as costs associated with frequency of dressing 

changes, physician (surgeon) and nursing time, 

effectiveness in relation to time-to-heal, quality 

of healing (avoidance of ulcer recurrence), ability 

to return to paid employment and the cost of the 

care setting.

141,142

 Cost-cutting exercises that focus 

on the use of less costly dressings could in fact 

result in higher overall costs, if dressing-change 

frequency is increased (necessitating increased 

nursing time) and time-to-heal is extended.

A number of reports have demonstrated the 

cost-effectiveness of different technologies and 

dressings used for the treatment of hard-to-heal 

wounds. Although many of these products are 

more expensive than the comparison treatment, 

the use of them may be cost-effective, if they 

result in less frequent dressing changes and/ 

or in more effective or faster healing.

136,143,144

 It 

is important to be aware that a treatment could  

be cost-effective in one group of patients or for 

one type of wound, but not in another type.  

An intervention could also be cost-effective  

when used in one setting or country but not  

in another.

138,139,145

Surgicalprocedures(theatretime,cliniciantime,disposables)

Frequencyofdressingchangesandbywhom(staff,patient,family)

Debridement(material,numberofprocedures,time,categoryofstaff) Dressings,drugs,andotherdisposablesandappliances

Inpatientstay(bed-days,clinic)

Antibioticsandotherdrugs(duration,dosage)

Diagnosticandlaboratorytests

Complicationsandadversereactions

Facilitytimeandvisits(clinicoroutpatientsetting,categoryofstaff)

Outcome:timetoheal,healingrate,timetocleanulceretc.