How CCGs can dramatically improve outcomes and costs in wound care

Venous Leg Ulcers (VLUs) affect between 60,000 and 180,000 people in the UK. They are distressing to the patient and need regular treatment once or twice a week. They also impose substantial costs on the NHS, which are rising steadily because prevalence increases with age.

Venous ulcers are thought to be caused by improperly functioning venous valves (SPL)
Venous ulcers are thought to be caused by improperly functioning venous valves (SPL)

There are two approaches to wound care: ‘usual care’, which is provided by generalist community nurses in patients’ homes, or by generalist practice nurses on GP premises, and ‘systematic care’, provided by specialist nurses in patients’ homes or specialist clinics.

The systematic approach is delivered by nurses who are experienced in the use of techniques required to treat VLUs and other wounds, and have access to specialist equipment.

Patients are carefully assessed and in most cases treated with regimented compression therapy. There is a growing body of empirical evidence that the systematic approach delivers more rapid healing rates. However, usual care is still the norm.

Cost effectiveness study carried out by KPMG

Healogics is a specialist wound healing company. We understand the importance of delivering expert treatment in the community, keeping patients out of hospital and delivering care closer to home. Our aim is to open more centres around the UK.

We asked KPMG to carry out a cost-effectiveness analysis of our systematic approach to VLU treatment and to compare the costs and patient outcomes to those achieved by usual care and other NHS clinical approaches. The full report is available to download here.

More about Healogics

Healogics is a specialist wound healing company that understands the importance of delivering expert treatment in the community.

This article is provided by Healogics

The cost of wound care is mainly driven by the cost of nurses’ time. Other costs include premises and bandages and, for community nurses, travel costs. KPMG estimates costs of £50 per week for systematic care and £79 per week for usual care. Systematic care will initially cost more per contact, but overall treatment will cost less as fewer patient contacts will be required due to overall treatment time being reduced for those patients who reach healing.

For the purpose of this study, Healogics charged a fixed fee of £1,206 for simple cases and £1,782 for complex cases. Given that 80% of patients are categorised as simple cases, this results in a cost per patient of £1,321.

Systematic care is more intensive and costs more to implement on a per contact basis than NHS usual care, but compression bandaging - a critical element in NHS systematic care - remains in place for much longer than other bandaging methods, which is why the number of weekly contacts is lower.

Study shows Healogics achieves higher overall healing rates

KPMG analysed the medical records of 84 patients treated in the Healogics Wound Healing Centre, Eastbourne, between 2008 and 2011, and 1,715 VLU patients treated in 80 Healogics Wound Care Centers in the US between 2011 and 2013.

The results indicate that the Healogics approach heals patients more quickly than both NHS usual and systematic approaches, and achieve higher overall healing rates (84% and above) than NHS treatments (between 50% and 70%).

This means that under usual care, 50 people in each cohort of 100 patients still require treatment after a year compared with around 15 under the Healogics approach.

Ten-year simulation demonstrates £10m saving for a CCG

KPMG also created a simulation to test the benefits of the Healogics approaches over a longer period, calculating the annual cost of treating a cohort of 1,000 patients from the time of entering the system until healed.

The key source of savings under the systematic approaches (including Healogics) is the dramatic reduction in the number of patients requiring treatment for the second and subsequent year.

This means that a CCG with 1,000 VLU patients could, by buying Healogics care, make savings in the order of £10m over a ten-year period.

  • James Saunders is business development director of Healogics.

Download the full report: A cost-effectiveness analysis of the Healogics Venous Leg Ulcer treatment when compared to NHS clinical approaches

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