An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds

• Published in: Value in health Vol. 21; no. 1; pp. 27 - 32
• Main Authors: Nussbaum, Samuel R., Carter, Marissa J., Fife, Caroline E., DaVanzo, Joan, Haught, Randall, Nusgart, Marcia, Cartwright, Donna
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2018; Elsevier Science Ltd
• Subjects: Aged; Beneficiaries; Chronic Disease; Clinical outcomes; Cost analysis; Cost-Benefit Analysis; Diabetes mellitus; Feet; Female; Health care expenditures; Health Policy; Health status; Humans; Infections; Inpatient care; Lesions; Male; Medicare; Medicare - economics; Medicare 5% Limited Data Set; Medicare spending; Outpatients; Pneumonia; Pressure ulcers; prevalence of wounds; Retrospective Studies; Skin disorders; Ulcers; United States; wound care; Wound healing; Wounds and Injuries - economics; Wounds and Injuries - therapy; Medicare 5% Limited Data Set; wound care; Medicare spending; prevalence of wounds
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.07.007

The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.
This retrospective analysis of the Medicare 5% Limited Data Set for calendar year 2014 included beneficiaries who experienced episodes of care for one or more of the following: arterial ulcers, chronic ulcers, diabetic foot ulcers, diabetic infections, pressure ulcers, skin disorders, skin infections, surgical wounds, surgical infections, traumatic wounds, venous ulcers, or venous infections. The main outcomes were the prevalence of each wound type, Medicare expenditure for each wound type and aggregate, and expenditure by type of service.
Nearly 15% of Medicare beneficiaries (8.2 million) had at least one type of wound or infection (not pneumonia). Surgical infections were the largest prevalence category (4.0%), followed by diabetic infections (3.4%). Total Medicare spending estimates for all wound types ranged from $28.1 to $96.8 billion. Including infection costs, the most expensive estimates were for surgical wounds ($11.7, $13.1, and $38.3 billion), followed by diabetic foot ulcers ($6.2, $6.9, and $18.7 billion,). The highest cost estimates in regard to site of service were for hospital outpatients ($9.9–$35.8 billion), followed by hospital inpatients ($5.0–$24.3 billion).
Medicare expenditures related to wound care are far greater than previously recognized, with care occurring largely in outpatient settings. The data could be used to develop more appropriate quality measures and reimbursement models, which are needed for better health outcomes and smarter spending for this growing population.