Improved Wound Management At Lower Cost: A Sensible Goal For Australia Dr Rosana Elizabeth Pacella Norman (PhD) AusHSI - Australian Centre for Health Services Innovation School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia 1

About AusHSI- Australian Centre for Health Services Innovation

Economic burden of chronic wounds in Australia US$ 2.85 billion annually 2% of the total national health expenditure

Evidence-practice gap ONLY 6.3% receiving compression ONLY 50% of patients had seen a podiatrist

Barriers to implementation of evidence-based wound care Medicare, Australia’s universal health insurance scheme, reimburses care provided outside hospital (MBS-Medicare Benefits Schedule) Under the Pharmaceutical Benefits Scheme (PBS), the government subsidises the cost of medicine for most medical conditions. High costs and inadequate reimbursement Out of pocket payments Poor financial incentives for evidence-based practice Lack of clinical skilled staff Poor co-ordination across health sectors Difficulties in accessing wound care

Health service pathways for chronic wounds

Economic and societal burden of poor implementation Extended healing times High recurrence rates Frequent assessment from health professional Hospitalisation due to complications

2 1 Australian Loses a lower limb How big is the issue? In Diabetic Foot Conditions alone 2 hours 1 Australian Loses a lower limb as a direct result of diabetes-related foot disease Every Globally a limb is lost every 20 seconds

Venous Leg Ulcer Hospitalisations 6-12% of patients 60+ years 18 days in hospital (Cellulitis) Cost $27,528.12 Australia hospital separations related to VLU by DRG-(AR-DRG VERSION 7.0, Round 18 (2013-14)

Is evidence-based wound care good value for money? Additional government investment Future cost-savings from optimal care

Diabetic Foot Ulcers (DFU)

What we did Probabilities of healing, needing amputations Simulated optimal care vs usual care for 5 years Optimal care = Australian official guidelines MBS and PBS reimbursement linked to services devices and consumables

Usual care vs. Optimal care Methods Usual care vs. Optimal care   Usual Care Optimal care Treatment 1. One-off initial assessment by GP 2. Low-Adherent, Absorbent Dressings, twice a week 3. post-operative boots 4. Infection management (systemic antimicrobials) 1. One-off initial assessment to by both podiatrist and GP 2. Debridement of non-ischaemic wounds 3. Appropriate dressings (Soft-gelling cellulose fibre + foam) twice a week 4. Pressure offloading 5. Multi-disciplinary care 6. Infection management (topical and systemic antimicrobials) Prevention None 1.Appropriate footwear 2.Podiatrist visit every two months

Our Results for Diabetic Foot Ulcers Costs in Australian Dollars for 2013 QALYs= Quality-Adjusted Life years A cost-effectiveness analysis of optimal care of diabetic foot ulcers in Australia. International Wound Journal 2016

Optimal care of DFU is a cost saving strategy and improves health outcomes High risk individuals receive optimal care Cost savings: $ 2.7 billion Over 5 years

Venous Leg Ulcers (VLU)

Optimal care of VLU is a cost saving strategy and improves health outcomes Compression therapy $500 m Cost savings: $1.4 billion Over 5 years individuals receive optimal care Unpublished data

Higher Costs Fewer QALYs More QALYs Usual Optimal care for chronic wounds Always a good decision Lower Costs

So how do we get there? Scarcity of resources will continue to be a challenge Evidence on cost-effectiveness Translated to real world outcomes

Recommendations EB wound products and services listed on MBS/PBS Identify areas and opportunities for disinvestment, redirect these savings toward high value services We need a cohesive health system working together in strong partnerships Incentivise cost-effective care and prevention within MBS Improve education and training of health professionals Patient education Establish Australian National Wound Registry

Acknowledgments Michelle Gibb, Anthony Dyer, Jennifer Prentice, Stephen Yelland, Qinglu Cheng, Peter Lazzarini, Keryln Carville, Karen Innes-Walker, Kathleen Finlayson Helen Edwards and Nicholas Graves

Thank you for listening