Cost-effectiveness analysis of guideline-based optimal care for venous leg ulcers in Australia

Abstract

BackgroundVenous leg ulcers (VLUs) are expensive to treat and impair quality of life of affected individuals. Although improved healing and reduced recurrence rates have been observed following the introduction of evidence-based guidelines, a significant evidence-practice gap exists. Compression is the recommended first-line therapy for treatment of VLUs but unlike many other developed countries, the Australian health system does not subsidise compression therapy. The objective of this study is to estimate the cost-effectiveness of guideline-based care for VLUs that includes public sector reimbursement for compression therapy for affected individuals in Australia.MethodsA Markov model was designed to simulate the progression of VLU for patients receiving guideline-based optimal prevention and treatment, with reimbursement for compression therapy, and then compared to usual care in each State and Territory in Australia. Model inputs were derived from published literature, expert opinion, and government documents. The primary outcomes were changes to costs and health outcomes from a decision to implement guideline-based optimal care compared with the continuation of usual care. Sensitivity analyses were performed to test the robustness of model results.ResultsGuideline-based optimal care incurred lower total costs and improved quality of life of patients in all States and Territories in Australia regardless of the health service provider. We estimated that providing compression therapy products to affected individuals would cost the health system an additional AUD 270 million over 5 years but would result in cost savings of about AUD 1.4 billion to the health system over the same period. An evaluation of unfavourable values for key model parameters revealed a wide margin of confidence to support the findings.ConclusionsThis study shows that guideline-based optimal care would be a cost-effective and cost-saving strategy to manage VLUs in Australia. Results from this study support wider adoption of guideline-based care for VLUs and the reimbursement of compression therapy. Other countries that face similar issues may benefit from investing in guideline-based wound care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3234-3) contains supplementary material, which is available to authorized users.

Associations between patient, treatment, or wound‐level factors and venous leg ulcer healing: Wound characteristics are the key factors in determining healing outcomes

“…Because every day that a VLU is present doubles the cost of treatment and increases the risk of infection, understanding what factors aid or inhibit healing is needed to promote healing. The reduction in health services costs as a result of timelier healing has been calculated at AUD1.2 Billion in recent economic modeling estimates …”

“…The reduction in health services costs as a result of timelier healing has been calculated at AUD1.2 Billion in recent economic modeling estimates. 15 A number of studies 9,12 have identified some key factors that inhibit or promote wound healing. Broadly, these factors fall under three categories.…”

Reimbursement for the cost of compression therapy for the management of venous leg ulcers in Australia

“…An evaluation of unfavourable values for key parameters in this model showed a wide margin of confidence to support the findings. A large body of related research as part of a health economics collaboration between academics, health professionals, and industry partners supports these findings, with similar modelling indicating that reimbursement for compression products increases patients' health‐related quality of life and quality‐adjusted life expectancy …”

“…Use of treatments that are maximally effective and cost‐effective is essential to the ongoing viability of Australia's health care system. Our research modelling the costs of the provision of compression therapy products to people with VLUs, as part of broader evidence‐based care, has shown it would cost the Australian health system an additional AUD 270 million over 5 years to fund compression therapy, but would result in a cost saving in the same period of AUD 1.4 billion and improve patient outcomes . The model takes into account the ageing population, new incident VLU cases that develop over time, recurrence, and hospitalisations.…”

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence

“…Chronic wounds are associated with a significant health-related quality of life burden and carry high economic costs to society in high income countries (Graves and Zheng, 2014;Guest et al, 2017;Cheng et al, 2018;Olsson et al, 2019). Prevalence is projected to increase due to an aging population and increasing incidence of obesity, diabetes, and cardiovascular diseases .…”