title: The humanistic and economic burden of chronic wounds: a protocol for a systematic review.
abstract: Chronic non-healing wounds present a substantial economic burden to healthcare system; significant reductions in quality of life for those affected, and precede often serious events such as limp amputations or even premature deaths. This burden is also likely to increase with a larger proportion of elderly and increasing prevalence of life-style diseases such as obesity and diabetes. Reviews of the evidence on the burden of illness associated with chronic wounds have not been comprehensive in scope and have not provided an assessment of the distribution of the health care costs across categories of resource use.
  
  
  
  This study is a systematic review of multiple databases for studies on adult patients with chronic wounds and with the primary objective to assess the impact on health-related quality of life by category of ulcers, and associated direct and indirect costs. Eligible studies will primary be empirical studies evaluating, describing or comparing measurement of quality of life and economic impact. Two reviewers will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form. Differences in applied methodologies and uncertainties will clearly be accounted for. Conservative valuations of costs and impact on health-related quality of life will be prioritised. Variations that may depend on age distribution, the categorisation of ulcer, healthcare system etc. will be described clearly.
  
  
  
  The proposed systematic review will yield a comprehensive assessment of the humanistic and economic burden of chronic wounds in an adult population. A better understanding of the humanistic and economic burden of chronic wounds is essential for policy and planning purposes, to monitor trends in disease burden and not at least in order to estimate the real-world cost-effectiveness of new treatments and therapies.
  
  
  
  PROSPERO CRD42016037496.
authors.affiliation: Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore.
authors.forename: Krister
authors.initials: K
authors.lastname: Järbrink
authors.affiliation: Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore.
authors.forename: Gao
authors.initials: G
authors.lastname: Ni
authors.affiliation: Department of Dermatology, Skåne University Hospital, Lasarettsgatan 15, 221 85, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sönnergren
authors.affiliation: Dermatology and Innate Immunity Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore.
authors.forename: Artur
authors.initials: A
authors.lastname: Schmidtchen
authors.affiliation: Medical Library, Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
authors.forename: Caroline
authors.initials: C
authors.lastname: Pang
authors.affiliation: Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore.
authors.forename: Ram
authors.initials: R
authors.lastname: Bajpai
authors.affiliation: Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore. josip.car@imperial.ac.uk.|Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK. josip.car@imperial.ac.uk.
authors.forename: Josip
authors.identifier: 0000-0001-8969-371X
authors.initials: J
authors.lastname: Car
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000523:psychology; D017281:Cost of Illness; D006801:Humans; D011788:Quality of Life; D000078202:Systematic Reviews as Topic; D014947:Wounds and Injuries / Q000191:economics* / Q000523:psychology
keywords: Chronic wounds; Cost of illness; Costs and cost analysis; Economics; Hard-to-heal ulcers; Health-related quality of life; Quality of life; Quality-adjusted life years