Swansea Centre for Health Economics, Swansea University and Welsh Wound Innovation Centre, Pontyclun, UK.
Swansea Centre for Health Economics, Swansea University, Swansea, UK.
Int Wound J. 2016 Dec;13(6):1193-1197. doi: 10.1111/iwj.12443. Epub 2015 Mar 26.
Chronic wounds are known to represent a significant burden to patients and National Health Service (NHS) alike. However, previous attempts to estimate the costs associated with the management of chronic wounds have been based on literature studies or broad estimates derived from incidence rates and extrapolations from relatively small-scale studies. The aim of this study is therefore to determine the extent of resource utilisation by patients classed as having chronic wounds within Wales using linked routine data - available through the Secure Anonymised Information Linkage (SAIL) database - to estimate the costs associated with the management of these patients by the NHS in Wales. The SAIL database brings together, and anonymously links, a wide range of person-based data from general practitioner (GP) practices within Wales, which includes primary and secondary care consultations to create an encrypted anonymised linking field for each individual. This linkage allows the patient pathway to be tracked through the NHS system both retrospectively and prospectively from a specific reference date. The estimated costs were derived by extrapolating to an all-Wales level from the results gleaned from the SAIL database using the respective READ codes to capture relevant patients with chronic wounds. The number of patients identified as having chronic wounds within the SAIL database was 78 090, which equates to 190 463 across Wales as a whole and a prevalence of 6% of the Welsh population. The total cost of managing patients with chronic wounds in Wales amounted to £328·8 million - an average cost of £1727 per patient and 5·5% of total expenditure on the health service in Wales. A relatively few READ codes represented a significant proportion of expenditure, with diabetic foot ulcers, leg ulcers, foot ulcers, varicose eczema, bed sores and postoperative wound care constituting 93% of total expenditure. When a more conservative perspective was used in relation to classification of chronic wounds, the total cost amounted to £303 million. However, these are likely to be underestimates because of the lack of information for patients with treatments lasting over 6 months and not including patients who might have entered the health care system of wound management elsewhere - such as patients contracting pressure ulcers in hospitals and having surgical wound infections.
慢性伤口给患者和英国国家医疗服务体系（NHS）带来了巨大的负担。然而，以前估算与慢性伤口管理相关的成本的尝试都是基于文献研究或根据发病率和相对小规模研究的推断得出的广泛估计。因此，本研究的目的是使用通过安全匿名信息链接（SAIL）数据库提供的链接常规数据来确定威尔士境内被归类为患有慢性伤口的患者的资源利用程度，以估算威尔士 NHS 管理这些患者的成本。SAIL 数据库汇集了来自威尔士全科医生（GP）实践的广泛的基于个人的数据，并对其进行匿名链接，其中包括初级和二级保健咨询，为每个个体创建一个加密的匿名链接字段。这种链接允许从特定参考日期开始，通过 NHS 系统对患者的路径进行回溯和前瞻性跟踪。通过从 SAIL 数据库中获取的结果中使用各自的 READ 代码推断出威尔士的总体情况，得出了估算的成本，以捕获患有慢性伤口的相关患者。在 SAIL 数据库中确定的患有慢性伤口的患者数量为 78090 人，相当于整个威尔士有 190463 人，占威尔士人口的 6%。威尔士管理慢性伤口患者的总成本为 3.288 亿英镑，每位患者的平均成本为 1727 英镑，占威尔士卫生服务总支出的 5.5%。少数几个 READ 代码占了支出的很大一部分，其中糖尿病足溃疡、腿部溃疡、足部溃疡、静脉曲张性湿疹、褥疮和术后伤口护理占总支出的 93%。当从慢性伤口分类的更保守的角度来看时，总成本达到了 3.03 亿英镑。然而，由于缺乏治疗时间超过 6 个月的患者信息，并且不包括可能已经在其他地方的伤口管理医疗系统中接受治疗的患者，如在医院患有压疮和手术伤口感染的患者，这些数字可能被低估了。
