Health economic burden that different wound types impose on the UK's National Health Service
Health economic burden that different wound types impose on the UK's National Health Service
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DOI：
10.1111/iwj.12603
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发表时间：
2017-04-01
影响因子：
3.1
通讯作者：
Vowden, Peter
中科院分区：
文献类型：
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作者：
Guest, Julian F.;Ayoub, Nadia;Vowden, Peter
这项研究的目的是估计2012/2013年度英国国家医疗服务体系(NHS)因管理不同类型的伤口而产生的护理模式和每年的医疗资源使用水平，以及NHS在管理这些伤口方面的年度成本。这是对健康改善网络(Thin)数据库中2000名患者记录的回溯性队列分析。量化了患者的特征、与创伤相关的健康结果和所有医疗资源的使用，并按2013/2014年的价格估计了NHS患者管理的总成本。据估计，2012/2013年间，NHS管理了220万名伤口患者。患者在社区主要由全科医生(GP)和护士管理。NHS每年的费用从19.4亿英镑到8960万英镑不等，前者用于治疗73.1万个腿部溃疡，后者用于治疗8.7万个烧伤和相关的并发症。61%的伤口平均在一年内痊愈。与管理未愈合的伤口相关的资源使用大大多于管理已愈合的伤口(例如，实习护士就诊增加20%，社区护士就诊增加104%)。因此，在研究期间愈合的伤口的年度管理成本估计为21亿英镑，而39%的伤口在研究年度内未愈合的伤口的管理成本为32亿英镑。在研究期间，每个愈合伤口的成本从每个患者698英镑到3998英镑不等，而一个未愈合伤口的成本从每个患者1719英镑到5976英镑不等。因此，未愈合的伤口的病人护理费用平均比愈合的伤口高135%。现实世界的证据突显了创伤在平均一年给NHS带来的巨大负担。侧重于(A)伤口预防、(B)准确诊断和(C)提高伤口愈合率的策略可以为患者和NHS带来临床和经济利益。
The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to the management of different wound types by the UK's National Health Service (NHS) in 2012/2013 and the annual costs incurred by the NHS in managing them. This was a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and all health care resource use were quantified, and the total NHS cost of patient management was estimated at 2013/2014 prices. The NHS managed an estimated 2.2 million patients with a wound during 2012/2013. Patients were predominantly managed in the community by general practitioners (GPs) and nurses. The annual NHS cost varied between 1.94 pound billion for managing 731 000 leg ulcers and 89.6 pound million for managing 87 000 burns, and associated comorbidities. Sixty-one percent of all wounds were shown to heal in an average year. Resource use associated with managing the unhealed wounds was substantially greater than that of managing the healed wounds (e.g. 20% more practice nurse visits, 104% more community nurse visits). Consequently, the annual cost of managing wounds that healed in the study period was estimated to be 2.1 pound billion compared with 3.2 pound billion for the 39% of wounds that did not heal within the study year. Within the study period, the cost per healed wound ranged from 698 pound to 3998 pound per patient and that of an unhealed wound ranged from 1719 pound to 5976 pound per patient. Hence, the patient care cost of an unhealed wound was a mean 135% more than that of a healed wound. Real-world evidence highlights the substantial burden that wounds impose on the NHS in an average year. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (a) wound prevention, (b) accurate diagnosis and (c) improving wound-healing rates.