Background: Choosing compression systems is often at discretion of the clinician, who considers the effectiveness of the system coupled with individual patient characteristics. Cost considerations are usually considered lower priority. With the looming reimbursement changes favoring bundled charges for the episode of care, interventions to control cost without sacrificing clinical outcomes. A recent meta-analysis comparing short stretch bandages (SSB) to 4-layer compression (4-LC) did not report significant differences in healed ulcerations.
Purpose: We examined the economic and clinical use of a super-absorbent dressing*(S-AD) under the SSB** for the management of venous leg ulcers (VLUs).
Method: The S-AD, having comparative data to other S-ADs showing lowest effect on sub-bandage pressures when fully expanded2, was applied as a primary or secondary dressing and secured with cotton undercast padding, fluffy rolled gauze or self-adherent wrap. If a primary dressing was needed, a calcium alginate or a foam dressing was used. Compression was applied using a SSB. Costs of care were compared to application of 4-LC. Reimbursements in the outpatient wound center were also calculated.
Results: Cost to outpatient wound clinic for S-AD with SSB method requiring an average of x3/week change, usually performed weekly at wound center and x2/week by home health when determined to be appropriate – usually with in one month of initiating S-AD/SSB method – was reduced by $374.00. Per visit reimbursement remained stable resulting in a $779.00/patient/month reduction in operating costs. There were no impacts in aggregate healing rates. Patients experienced overall reduction in co-pays and travel costs. Home health agencies experienced a reduction in visits.
Conclusion: The use of a S-AD dressing that has the least impact on sub-bandage pressures under a SSB is a viable option to achieve clinical outcomes for VLU patients while simultaneously reduce cost of care. More study is warranted.