In 2014, AusHSI partnered with the Wound Management Innovation Cooperative Research Centre (WMI CRC) in a large-scale health economics collaboration, led by Associate Professor Rosana Pacella. Rosana established a wound team at AusHSI including Ruth Tulleners, Louise Barnsbee, Laura McCosker, Tamzin Pacella, PhD students Qinglu Cheng and Yuqi Zhang, health economist Dr David Brain, with Dr Xing Lee providing statistical support. The AusHSI wound team also worked in close collaboration with several national and international experts in wound management.
The Wound Management Innovation CRC ended on the 30thof June 2018; however its partnership with AusHSI has resulted in lasting collaboration, results, publications and progress. The work of Associate Professor Rosana Pacella and the team at AusHSI has provided a wealth of contemporary and high-quality evidence for those with the job of convincing policy makers that this very real issue deserves a lot more action than it currently receives.
Measuring costs and quality of life for Venous Leg Ulcers
Venous Leg Ulcers (VLUs) make up approximately 12% of chronic wounds diagnosed in Australia, and the key treatment for this condition is compression therapy, either through bandaging or specialised hosiery. Despite this treatment being described as optimal (and best practice), many sufferers do not receive it. A significant factor behind this is the high cost of these bandages – a cost currently not subsidised through Medicare or the Pharmaceutical Benefits Scheme (PBS).
A project run by Rosana and her team quantified the out-of-pocket and health system costs of the care of this condition using information collected from patients suffering from this condition, and demonstrated the significant cost savings to the health system that could be made with widespread use of best practice treatment. Find out more about the results of this study.
Results such as these are delivered to policy makers, and make a strong case for reimbursement of compression therapy and other wound dressings and services.
Evaluation of an innovative model of care for chronic wounds patients
Wound Innovations is the practical and clinical translation of the WMI CRC. It is a unique and innovative service, improving patient outcomes through clinical best practice, transdisciplinary care, education programs and research. It has been operational since 2017, and AusHSI has worked closely with the clinic since its inception.
AusHSI completed an economic evaluation of the service, measuring patient outcomes and costs prior to enrolment at the clinic, and following patient journeys for three months. Many patients attending this clinic have previously been told their wounds are unhealable, have been misdiagnosed, or are at immediate risk of amputation. Despite the severity of these wounds affecting healing times and higher costs of this specialist clinic, results from the economic evaluation indicate a benefit in accessing this model of care, both from an economic and patient outcome perspective. Click here to read more about the patient outcomes from this study.
To evaluate the cost-effectiveness of the clinic, a decision-analytic model was used, utilising retrospective and prospective data from a cohort of wounds patients, as well as information from administrative databases and published literature. The results showed specialist wound clinics to be cost-effective for the management of chronic wounds – on average, specialist clinics were cheaper than usual clinics and resulted in a quality adjusted life year gain of 0.04 per patient, per year.
Unfortunately, specialist care such as this comes at a price that not all those who suffer can afford. Findings from the AusHSI wound research team is currently being used to campaign for improved access through government subsidy and reimbursement, to allow a wider group of patients in need to access this high quality care.
To read more about the outcomes of the economic evaluation, click here. The findings from this study were presented by Dr David Brain at the Australian Public Health Conference in Cairns in September 2018, and the Australasian Epidemiological Association (AEA) Annual Scientific Meeting in Perth in October 2018.
Chronic Wounds Solutions Forum
One of the broader projects that AusHSI has conducted during this collaboration is the organisation of a national forum in August 2017, to discuss the solutions to the many barriers chronic wound sufferers face when attempting to access best-practice care. This forum was hosted by AusHSI, in partnership with Queensland Government, Metro North Hospital and Health Service, Clinical Excellence Division, Brisbane North Primary Health Network and the WMI CRC. The forum brought together healthcare providers, policy makers, patients, carers and researchers from Queensland and around Australia, and the day-long event encouraged those at the coal face of wound management to share their perspectives and suggestions on what should be done to address the growing epidemic of chronic wounds in Australia. In the months following this event, further surveys, discussion and collaboration occurred to collate and refine the hundreds of suggestions into a list of specific recommendations. These recommendations were written into a document titled ‘Solutions to the Chronic Wound Problem in Australia: A Call to Action’ – this detailed report describes recommendations in detail, along with national and international examples of how these suggested practices have been implemented successfully. The end of the document lists specific actions for all those involved in wound management, from a federal government level, down to patients and carers.
This report was launched on 15 March 2018, and has garnered widespread attention and interest from those in the wound care industry. Wounds Australia has used the document to inform their ‘5 Point Plan’ to reduce the burden of chronic wounds in Australia, resulting in initiatives such as the introduction of credentialing for clinicians specialising in wound care, and the launch of their public education videos online.
In the time since the paper was launched, Rosana presented the document at the Metro North Health Forum in June 2018. Ruth Tulleners presented an update on the document at Wound Australia’s ‘Wound Awareness Week’ celebrations in July 2018, and at the Australian Public Health conference in September 2018. Qinglu Cheng disseminated the research and further updates through a poster presentation at the Wounds Australia conference in October 2018. Collaboration with the forum partners continues, and there is ongoing discussion and planning for implementing the recommendations into policy and practice.
If you require any more information regarding this work or if you would like to join the chronic wounds collaborating group to further this important research please contact Ruth Tulleners at AusHSI.
To read more publications from the AusHSI/WMI CRC Partnership, click below:
Cost-effectiveness analysis of guideline-based optimal care for venous leg ulcers in Australia
Improved wound management at lower cost: a sensible goal for Australia
A cost-effectiveness analysis of optimal care of diabetic foot ulcers in Australia
Economic Evaluations of Guideline-Based Care for Chronic Wounds: a Systematic Review
Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters