Improved Wound Management At Lower Cost: A Sensible Goal For Australia

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

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. How big is the issue? In Diabetic Foot Conditions alone 2 hours 1Australian 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 (2013-14)

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. Methods Usual care vs. Optimal care

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 More QALYs Fewer 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, • QingluCheng, • Peter Lazzarini, • Keryln Carville, • Karen Innes-Walker, • Kathleen Finlayson • Helen Edwards • and Nicholas Graves

24. Thank you for listening