THE ECONOMIC ASSESSMENT OF ADVANCED WOUND CARE PRODUCTS:
FROM RESEARCH THEORY TO PRACTICE
Alex Macario, MD, MBA. Assistant Professor of Anesthesia & Health Policy and Research,
Stanford University School of Medicine, California, USA

INTRODUCTION

Chronic wounds are a significant health problem around the world. Ulcers reduce quality of life and may lead to infections, pain, and death. While prevention of chronic wounds should be the primary goal, over the past decade, new adjunctive therapies have become available.¹ For pressure ulcers, for example, these therapies include applying electric and electromagnetic energy,² external negative pressure,³ wound normothermia,^4,5 low air loss beds,⁶ various dressings,⁷ skin substitutes,⁸ and growth factors.⁹

Regulators and payers want value for money for new products
While these products offer exciting opportunities for doctors and patients, there remain economic issues that require attention. Purchasers want proof of value. Among the specific topics that need further clarification are the processes and criteria that payers use to consider, adopt and finance new wound care treatments For example, should the federal government pay for these technologies? Should insurance companies have a list of acceptable wound care products that are deemed to be cost-effective? The choices health insurers make regarding new technologies may depend on how health economists - often working on behalf of the health insurers - conduct economic analyses of new wound care technologies.

The goal of this article is to present an overview of how health economists perceive economic analyses of new technologies such as advanced wound care products. This guide is intended as a roadmap to highlight the research methods. Although cost-effectiveness analysis is a specific type of economic evaluation, the term is commonly used (sometimes mistakenly) to refer to all types of economic evaluation in health care.

The application of economics to medical practice does not necessarily mean that less money should be spent, but rather that the use of resources might be more efficient. At some point, the extra money spent for small improvements in quality of medical care is not worthwhile. Economic study of wound care treatment aims to identify appropriate practice, because money misspent could have been devoted to medical care that would achieve greater benefit (e.g., vaccinations), or to some other meaningful social purpose (e.g., elementary school education). Since, there are not enough resources to provide all the medical care technically possible or that patients might prefer to receive, difficult trade-offs and choices will occur.

Healthcare systems, regardless of their financing and delivery systems, then must employ a number of mechanisms to ration these finite healthcare resources. This is because health care is different than consumer goods, which rely on the marketplace to get allocated optimally.

Table 1.
How is health care different from consumer goods?

In analyzing the economics of chronic wound care, three different dimensions can be considered.

This theoretical framework and the tools of analysis presented can be applied to all new technologies. The incremental cost-effectiveness ratio is defined as:

Incremental cost-effectiveness ratio = (C2 - C1) / (E2 - E1)

Where C2 and E2 are the cost and effectiveness of the new intervention being evaluated, and C1 and E1 are the cost and effectiveness of the standard therapy.
The take home message is that the cost-effectiveness of new technologies requires clinical effectiveness, is relative and incremental to the standard of care, can quantify the additional cost and the additional benefit, but not whether the treatment is 'worth it'.
Ideally, for example, the economic analysis, can then be used by decision-makers at the local treatment facilities or by national policy experts to make informed coverage decisions. Cost-effectiveness analysis is only one of many sources for informed decision making.