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Due to the nature of the Advanced Wound Management business more work has been carried out in the area of health economics than our other businesses. Advanced wound products are typically more expensive than traditional products, but it is important to focus on the total cost of patient care, rather than on the costs of individual components of care. As a result it is essential to look at the overall wound healing programme from initial diagnosis to wound closure to make a strong case for application of our advanced wound healing range.

In wound care the cost of products typically represent no more than 10-15% of total treatment cost. The dominant cost is the cost of labour. Thus, the practical application of our strategic aim requires that we seek solutions which reduce overall costs by substituting the cost of wound care products for the cost of medical and nursing time. In the new paradigm, the cost of products will come to account for a higher share of the total cost of treating patients. The case studies discussed in this section illustrate these principles.

It is generally agreed that wound debridement helps to create a wound environment which is conducive to healing. Surgical debridement is quick and effective: sharp instruments such as scalpel, scissors or curette are used to remove devitalised tissue and bacterial contamination from the wound. Surgical debridement is normally carried out in an operating theatre under general anaesthetic.

A new technology (VERSAJET^◊) has recently been approved in the UK and US for the surgical debridement of wounds. It uses a fluid jet under high pressure (up to 15,000 psi) to cut and evacuate necrotic tissue. The new technology is safer and more selective than conventional instruments and offers greater precision. Compared with a scalpel, the fluid jet more completely removes devitalised tissue and at the same time spares collateral healthy tissue. The benefit to the patient is that the wound is expected to close more quickly and the quality of scarring is better.

The price of the new instrument is significantly higher than the price of conventional instruments. The price of a disposable VERSAJET^◊ handpiece is nearly 40 times the price of a scalpel blade. However, the greater precision of the instrument means that it is possible to prepare a wound for closure with fewer operative procedures. In a recent US evaluation, the median number of surgical debridements required was reduced from two per wound with conventional instruments to one with VERSAJET^◊. This difference was statistically significant¹.

In the US evaluation, the total cost of debridement was $4,571 per patient with VERSAJET^◊ compared with $6,448 with conventional instruments. Despite the fact that the new technology costs more initially, because it saves operating theatre, nurse and surgeon time, the overall cost of treatment was reduced by approximately $1,900 per patient.

Not all of this saving will be in cash, although there will be some cash saving. Most of the saving will be in the form of nursing, surgeon and operating theatre time. All of these resources have alternative uses, and releasing nursing and surgeon time makes it possible to treat more patients with the same capacity.

A venous leg ulcer is a chronic wound which, if not treated appropriately, can endure for years. The wound can be painful and will often restrict physical and social mobility. Patients are typically treated by a community nurse at home or in a specialist clinic. There are more than 200,000 new venous leg ulcers annually in the UK.

It is well accepted that treatment with multi-layer high compression improves healing compared with no compression or low compression bandaging.² The superior performance of high compression compared with traditional dressings has two positive impacts on efficiency:

• The use of high compression in appropriate patients leads to shorter healing times and lower treatment costs overall.
• Because of the greater durability of high compression bandages compared with traditional products, wear time is longer and costs are reduced by the lower frequency of dressing changes.

These benefits have been demonstrated in a number of studies. One study³ compared clinical outcomes for patients with a venous leg ulcer treated with multi-layer high compression and the usual care provided by community nurses in a typical health authority in England. Usual care involved many different treatments, including traditional non-compression dressings. In this study, after 24 weeks of treatment, 40% more patients were healed with high compression than with usual care. In the high compression group, nurses visited on average just over once a week to change dressings. With the cheaper products in the usual care regime, nurses visited more than twice a week.

An improvement in the efficacy of treatment is expected to lead to a reduction in the overall costs of patient care. Table 1 shows a comparison between the cost of treating a patient with a venous leg ulcer with PROFORE^◊ compared with the usual care provided by community nurses in a typical health district in England. Costs are based on the clinical results reported in a study by Morrell³. In this study PROFORE^◊ healed almost 40% more patients at 24 weeks and required fewer dressing changes (PROFORE^◊ was changed on average once per week compared with twice per week for the usual care regime). The expected saving in cost amounts to a reduction of 45% on the cost of usual care.

In a usual care regime, 80% of the total cost of care is the cost of nurse time. Thus, despite the fact that PROFORE^◊ costs more than the typical dressings used in a non-compression regime, overall treatment cost is lower with PROFORE^◊ because of the lower frequency of dressing changes and because of its greater efficacy.