Health Economics
- There are currently no effective treatments for wounds. With 2.3 million wounds in the UK in 2017, the annual direct costs of care reached £17.23 billion and are growing by 12% each year.
- A treatment, MPPT, has been developed and is available. By implementing this, the NHS could save an estimated £15.14 billion (range £14.2 bn to £15.8 bn).
- MPPT is a safe and easy-to-use anti-infective treatment for wounds.
- MPPT is effective against antimicrobial resistant infections.
- Antibiotics and antiseptics cause AMR – MPPT does not.
- 278 million annual wound dressing changes in the NHS (2017) produce huge amounts of waste – MPPT can reduce the number of changes substantially and is less polluting, e.g. no plastics.
- 70% of wounds are infected and their cleaning as well as dressings involve strongly polluting antimicrobials – MPPT contains only natural, biodegradable ingredients, and no antimicrobials.
Healthcare Costs of Wounds
The NHS “THIN” database contains over 11 million patient records from 550 general practices in the UK and has been shown to be representative of the UK. Guest et al. (2015, 2017a,b, 2018a,b) used this database to determine the outcome of wound care in the UK primary care. The data includes all activities after reporting, e.g. surgical procedures, imaging, outpatient clinics, community nursing etc.
They found the prevalence of wounds in community care in the UK to be 4.5% of the adult population – for 2017, this corresponds to 2.289 million wounds. Next, they determined the mean cost per wound for different wound types for the initial 12 months after first presentation to the NHS GP surgery. By combining the prevalence data for different wound types in community care with the average cost per wound for each wound type, it was possible to determine the total costs of wound care and this was a staggering £17.23 billion in 2017 for adults in community care.
In 2018, a survey was conducted among community nurses to determine the number of dressing changes they make in the course of a year. The study found that wounds on average required dressing change every second day and that the wounds remained open for an average of over 8 months (Wounds-UK 2018). Using the prevalence of wounds from Guest et al. (2015), there was in 2017 an estimated 278 million dressing changes annually. The NHS National Schedule of Reference Costs (2017) lists the average costs for community health services at £62 and, using this factor as cost per dressing change, the direct costs would be £17.27 billion annually, i.e. almost identical to the above estimate. Finally, using costing data from another EU-country, confirmed these levels of expenditure.
The burden of wound care in the UK, only covering the treatment of adults in community care, was therefore over £17 billion in 2017 – and these costs are increasing by 12% annually (Guest et al. 2017).
Healthcare Costs of Wounds
The NHS “THIN” database contains over 11 million patient records from 550 general practices in the UK and has been shown to be representative of the UK. Guest et al. (2015, 2017a,b, 2018a,b) used this database to determine the outcome of wound care in the UK primary care. The data includes all activities after reporting, e.g. surgical procedures, imaging, outpatient clinics, community nursing etc.
They found the prevalence of wounds in community care in the UK to be 4.5% of the adult population – for 2017, this corresponds to 2.289 million wounds. Next, they determined the mean cost per wound for different wound types for the initial 12 months after first presentation to the NHS GP surgery. By combining the prevalence data for different wound types in community care with the average cost per wound for each wound type, it was possible to determine the total costs of wound care and this was a staggering £17.23 billion in 2017 for adults in community care.
In 2018, a survey was conducted among community nurses to determine the number of dressing changes they make in the course of a year. The study found that wounds on average required dressing change every second day and that the wounds remained open for an average of over 8 months (Wounds-UK 2018). Using the prevalence of wounds from Guest et al. (2015), there was in 2017 an estimated 278 million dressing changes annually. The NHS National Schedule of Reference Costs (2017) lists the average costs for community health services at £62 and, using this factor as cost per dressing change, the direct costs would be £17.27 billion annually, i.e. almost identical to the above estimate. Finally, using costing data from another EU-country, confirmed these levels of expenditure.
The burden of wound care in the UK, only covering the treatment of adults in community care, was therefore over £17 billion in 2017 – and these costs are increasing by 12% annually (Guest et al. 2017).
Wound healing
The FDA (2016) in an Executive Summary of published clinical studies and clinical guidelines concluded that the current approach to wounds does not work: “The available evidence does not appear to demonstrate improved clinical outcomes from the use of antimicrobial dressings over non-antimicrobial dressings for the prevention or treatment of local wound infections or to improve wound healing.” A similar conclusion has been reached by NICE (2016). Guest et al. found that close to 70% of the wounds in community care were infected, but due to lack of alternatives, antibiotics and antimicrobial dressings remain the most commonly used products.
Table 1 compares the outcome for four common wound types during the first 12 months after presentation to the GP-surgery. The first column to the left shows the percentage of healed wounds during this initial 12 month period and the remaining columns demonstrate the impact of infection on healing. Wounds were considered infected if the patient had received oral antibiotics with or without an antimicrobial dressing. All wounds of a specific type from the very minor to the very severe were included. The table shows the percentage of wounds that healed, i.e. closed, within the first 12 months; time to closure for the percentage that achieved closure; and average cost per wound during the 12 months. The table highlights the enormous burden wounds place on patients and the healthcare system; and the impact infection has on outcome; this clearly demonstrates the limitations of existing treatments. The table also highlights the extended healing times as many wounds do not heal within the first year and this necessarily has huge impact on patient quality-of-life and secondary consequences, e.g. resulting from immobility. The table does not include the costs accumulating after the first year due to the wound remaining unhealed after the first year.
% healed within first 12 months | Time to closure for those closing (months) | Mean cost per patient (first 12 months) | |||||
| Total | No infec | Infection | No infec | Infection | No infec | Infection | |
| Pressure ulcers | 23% | 40% | 14% | 3.7 | 7.7 | £4,662 | £10,906 |
| Diabetic foot ulcers | 36% | 70% | 16% | 2.3 | 6.1 | £2,604 | £11,585 |
| Venous leg ulcers | 52% | 75% | 25% | 2.2 | 4.9 | £3,328 | £12,893 |
| Surgical wounds | 86% | 92% | 85% | 1.86 | 6.5 | £2,001 | £8,742 |
Table 1. No infection: Patient has not been treated with antibiotics or antimicrobial dressings. Infection: Patient has been treated with systemic antibiotics with or without an antimicrobial dressing.
MPPT – anti-infective treatment for wounds
MPPT has been studied extensively and Table 2 summarises the outcome of using MPPT on wounds and ulcers. The studies showed:
- The controlled, randomised preclinical and the controlled, randomised clinical study both found that MPPT reduced the time to a wound being free of infection and having started healing by 60% relative to a topical antibiotic. The clinical study also included iodine for comparison and found the same level of reduction by MPPT. Both studies found that quicker removal of infection resulted in faster wound healing. There is a high level of agreement between these findings.
- Clinical evaluations have consistently found that MPPT removes wound infections and promotes tissue regeneration. This has been seen in all wounds, including wounds that had failed to respond to a wide range of products traditionally used in wound care, i.e. antibiotics, antiseptics and NPWT (vacuum-pump). MPPT reduces malodour and pain caused by infection. Closure was achieved for wounds without secondary complications that would prevent wound closure. Any lack of closure could be used diagnostically to identify underlying conditions, e.g. osteomyelitis (bone infection).
- MPPT is effective in patients on immunosuppressant treatment, patients who were immunocompromised, and in patients with SCI (Spinal Cord Injury). No side-effects have been seen.
There is a high level of data consistency demonstrating that MPPT effectively removes wound infection and induces tissue regeneration and healing (Sams-Dodd et al. 2018). The wound healing effects are also seen for non-infected wounds. Both NICE (2016) and the FDA (2016) have concluded that antibiotics and antiseptics are ineffective against wound infections and in supporting healing. The use of MPPT will therefore lead to substantial cost-savings.
| Study | Outcome of MPPT-treatments |
| Preclinical study in wound model (Bilyayeva et al. 2014) | 60% quicker removal of wound infection compared to antibiotic and untreated control. Faster wound closure. |
| Clinical RCT comparing MPPT to topical antibiotic and topical antiseptic (Bilyayeva et al. 2017) | 266 patient study showing 60% quicker removal of wound infection compared to antibiotic and antiseptic. Faster healing by 31% on average. 42% estimated cost savings for acute wounds. |
| Clinical audit in dehisced surgical wounds (Ryan 2017) | Removal of wound infection and start of healing for 10 dehisced surgical wounds. 81% quicker effect compared to standard-of-care NPWT treatment. All wounds closed. 70% estimated cost-savings. |
| Case series in pyoderma gangrenosum (PG) ulcers (Lovgren et al. 2018) | Tissue regeneration in 3 non-responsive PG ulcers. Infection removal and tissue regeneration in 1 infected PG-ulcer. |
| Comparing MPPT to PHMB on healing wound (Sams-Dodd et al. 2019 submitted) | Removal of soft tissue infection and tissue regeneration in chronic non-healing wound on top of chronic osteomyelitis. No toxicity on tissue or bone. |
| Treatment of wounds and ulcers in SCI-patients (Sams-Dodd et al. in prep.) | Removal of wound and soft tissue infection and tissue regeneration in wounds and ulcers in all 12 wounds in SCI-patients. Wound closure in non-osteomyelitis cases. 92% estimated cost-savings. |
| Case-reports (on-file, in-house database) | Removal of wound and soft tissue infection and tissue regeneration in wounds and ulcers. Wound closure in cases without pre-existing secondary complications. |
Table 2. Summary of studies with MPPT outlining the scientific and medical evidence behind MPPT.
Cost-savings with MPPT
Using the THIN-database, Guest et al. determined for a range of wound types the cost-of-treatment for the first 12 months after presentation to a GP-surgery. This is currently the most accurate and up-to-date estimate available for the UK. In order to estimate the potential cost-savings by the introduction of MPPT in the NHS, the cost of treatment using MPPT in community care was determined for wounds less than 12 months old that had received MPPT. These costs were subsequently compared for each wound type and infection-status to the costs identified by Guest et al. Using these data, the average level of saving achieved by using MPPT was calculated and found to be 87.9% (range 82.9% to 91.6%). Most of the wounds in the MPPT group had been unsuccessfully treated with other products prior to MPPT (antibiotics, antiseptics, vacuum pump, honey), meaning that the wounds generally would be considered “difficult non-healing wounds” and not typical representations of first-presented wounds. However, despite this, they rapidly proceeded towards closure with MPPT.
Using these estimates, the level of savings to follow from the use of MPPT as first-line treatment would be £15.1 billion annually for adults in community care. Improved treatment of wounds will also have follow-on effects such as improved ability of independent living, faster return to work, fewer depressions, less follow-on conditions from physical inactivity and many others, and this will further result in reduced social care costs. As the cost-savings primarily will be obtained by reducing the time healthcare professionals need to attend wounds, this will release personnel for other tasks. Most dressing changes are carried out by nurses, of whom there is currently a shortage, and the reduction in surgical closure of wounds, e.g. pressure ulcers, will free up both surgeon and theatre capacity.
The data above are for community care, but the NHS Clinical Audit found cost-savings of 69.5% from using MPPT in secondary care on dehisced surgical wounds compared to NPWT, which generally is considered the most effective approach for dehisced surgical wounds. The comparative clinical study found, for acute wounds, savings of 42% relative to an antibiotic and an antiseptic. The level of savings that can be provided by MPPT in secondary care is therefore also very substantial, but due to lack of data on wound care in the secondary care sector the potential overall savings cannot be estimated.
Wounds are generally not an area attracting attention, but with an ageing population, increasing antimicrobial resistance and lack of effective wound treatments, it has become a huge burden on healthcare costs and on patients. The introduction of an effective treatment can therefore be expected to have a huge impact on this medical field – just as antibiotics had on the treatment of systemic infections, when they became available. Viewed in this context, the outlined benefits are realistic.
References
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Bilyayeva OO, Neshta VV, Golub AA, Sams-Dodd F. Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers. Wounds. 2017 Aug;29(8):1-9. Epub 2017 May 25.
FDA. FDA Executive Summary, Classification of Wound Dressings Combined with Drugs. Prepared for the Meeting of the General and Plastic Surgery Devices Advisory Panel. 2016; September 20-21, Page 38-39.
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Wounds-UK (2018) https://www.wounds-uk.com/news/details/new-research-finds-uk-nurses-carry-out-180-wound-dressing-changes-a-year-on-each-chronic-wound-patient-