1. 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

2. About AusHSI- Australian Centre for Health Services Innovation

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

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

6. 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

7. Health service pathways for chronic wounds

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

9. 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

10. 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 ( )

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

12. Diabetic Foot Ulcers (DFU)

14. 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

15. 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

16. 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

17. 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

18. Venous Leg Ulcers (VLU)

19. 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

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

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

22. 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

23. 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

24. Thank you for listening