title: Health economic burden that wounds impose on the National Health Service in the UK.
abstract: OBJECTIVE
  To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs.
  
  
  METHODS
  This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices.
  
  
  RESULTS
  Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was £5.3 billion. This was reduced to between £5.1 and £4.5 billion after adjusting for comorbidities.
  
  
  CONCLUSIONS
  Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity (£5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK Faculty of Life Sciences and Medicine, King's College, London, UK.
authors.forename: Julian F
authors.initials: JF
authors.lastname: Guest
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ayoub
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: McIlwraith
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Uchegbu
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Alyson
authors.initials: A
authors.lastname: Gerrish
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Weidlich
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust and University of Bradford, Bradford, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Vowden
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust and University of Bradford, Bradford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Vowden
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics*; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing; D014947:Wounds and Injuries / Q000191:economics*
keywords: HEALTH ECONOMICS; WOUND MANAGEMENT