Cath Lab Digest

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The value of cost-effectiveness research in all areas of healthcare, including wound care, is increasing. The purpose of this narrative review is to discuss and critically examine economic analysis methods and determine how current knowledge should be applied to wound care. Unlike evidence-based medicine, there is less agreement on how to conduct economic analyses in healthcare and universal guidelines for reporting these studies are lacking. A review of the literature shows that, in wound care, economic analysis is mostly limited to cost-benefit analysis with a limited time horizon; several examples specific to venous ulcers are presented. In addition, most analyses are models based on prospective studies; this is an especially important consideration because chronic wounds may take a long time to heal and/or recur. Other economic analyses that may be very useful to evaluate include those based on “real world” or practice-based studies, which provide results for all wound care populations and can be compared to facilitate development of cost-effective strategies for wound care treatment. Currently available cost-effectiveness study results may help healthcare providers devise cost-effectiveness strategies to embed in clinical practice guidelines that will save costs and improve patient quality of life.

Key Words: cost-benefit, cost-effectiveness, cost-utility, venous leg ulcers, diabetic foot ulcers

Index: Ostomy Wound Management 2010;56(11):

Potential Conflicts of Interest: none disclosed

  Debate in the US following the passage of major healthcare reform legislation has not waned, and the Obama administration continues to focus on cost savings and creating more efficient healthcare systems. Substantial cost savings in medicine can be achieved when we understand what works, how well it works, whether it is cost-effective,¹ and if this information can be satisfactorily applied to healthcare systems. Despite ongoing examination and discussion regarding rating schemes, evidence levels, and the effects of its implementation, evidence-based medicine (EBM) can help evaluate the “what works” piece of the puzzle.¹

  The American Recovery and Reinvestment Act (ARRA) emphasizes the importance of comparative effectiveness under the National Institutes of Health (NIH) Challenge Grants in Health and Science Research.² In the broadest of definitions, according to a 2007 Congressional Budget Office (CBO) white paper³ comparative effectiveness is “generating evidence that compares treatments.” The CBO also indicates that comparative effectiveness includes comparative economic analysis (see Table 1), as well as treatment outcomes research.

  What form should comparative economic analysis take? Although the CBO white paper indicates that cost-effectiveness studies are extremely important, no particular guidance is given. Similar to the pyramid of study evidence in EBM in which randomized controlled trails (RCTs) are considered the highest level of evidence, cost utility (CU) (see Table 1) often is considered the desirable gold standard by which treatment cost effectiveness should be measured.^3-6 However, there is no standard approach to CU with regard to modeling complexities. Moreover, other approaches may be helpful in comparing treatments in terms of economic costs and benefits or in generating data to input into more sophisticated CU models.