Cost and cost effectiveness of venous and pressure ulcer protocols of care

Background: To meet the challenge of an aging population, providers and pay ors 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-vali dated wound care protocol. Only modalities with a pooled evidence base of a t least 100 wounds were used to populate the model. Costs excluded supporti ve treatments. Results: 26 studies of three pressure ulcer protocols (n = 519) and three v enous ulcer protocols (n = 883) qualified for inclusion in the models. Afte r 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 $US 1873 to $US 15 053 for ve nous ulcers. For a hypothetical managed-care plan, the difference between t he least and most cost-effective modalities was $US 1.9 million for pressur e ulcers and $US5.8 million for venous ulcers. Observed differences were ge nerally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpati ent care settings; venous ulcers are managed on an outpatient basis. Physic ian visit frequencies are once every four weeks for pressure ulcers and onc e each week for venous ulcers. Wound sizes ranged from 2.5cm(2) to 5.6cm(2) for pressure ulcers and 5.4cm(2) to 10cm(2) for venous ulcers. All patient s with pressure ulcers required pressure relief, nutritional support and in continence management; venous ulcers required gradient compression. Costs p er patient healed were lowest for pressure ulcers with hydrocolloids and hi ghest with saline gauze (this is a manpower issue). Costs to heal venous ul cers were highest with human skin construct and lowest for 12-week manageme nt with hydrocolloid. Conclusions: Despite the limitations of the models (as a result of incomple te study data), this analysis confirms that defining wound care costs solel y as cost of products used is inaccurate and can be expensive.