Chapters Transcript Video Comparing the Costs A Data Driven Approach for NPWT Please join Amy Law and review the study results for patients who received traditional NPWT in the post-acute setting. Hi. Thank you for joining me today. I'm Amy Law, and I'm going to discuss a recent study and publication comparison of healthcare costs associated with patients receiving traditional negative pressure wound therapies in the post acute setting. By way of full disclosure, I am a three M employee. Here's some important background information, and the slides that I'm going to share today are from this study in particular. So, just by way of background, this is a similar analysis that we conducted back in 2013 that published in wounds in 2015. Since that time, there's been a growing awareness of the burden of wound care, particularly in the out of hospital setting. An outpatient use of durable or traditional negative pressure wound therapy has continued to grow both in the U. S and globally. And though although there continue to be many peer reviewed publications, few head to head studies exist. So the purpose of this study or the study objective was to evaluate total and wound related costs for acute and chronic room patients treated with N P W T. Comparing N p w, T k, or vac therapy and N. P, w, T o, which were all other non K CI models of negative pressure wound therapy. Again, this is looking at durable N P W T only so a summary of the method. This was a retrospective analysis of a national insurance claims database conducted by Optimum. This was funded by K CI, now three m, but then conducted by optimum analysts. And the data was owned and maintained by optimum. Over 15,000 patients were analyzed, who had an initial outpatient N P W T claim between January 2016 and Sept 2018, with continuous coverage visibility by that player six months prior to the claim in 12 months Post. Additionally, we also omitted any patients who had an out of hospital N p W t claim in the 12 months Prior trying to look at new wounds and really starting with a new episode of care. The patients were grouped by optimum to the initial M P W T system received again N P W T K, which is three times back therapy or N p w t o. The cohorts were propensity score matched based on recommendation of the analysts based on age, gender, comorbidities and player type, and then each cohort included 3368 patients. After matching, the costs were evaluated at 30 days, three months and 12 months for the two cohorts that we've mentioned. And then wounds were classified in the major categories based on ICD nine ICD 10 codes. Costs were then designated as wound related if the wound diagnosis appeared within the top three diagnoses of the claim. The one exception, of course, was for the pharmacy claims that don't have a diagnosis. Those were just put in the other cost bucket. Some of the baseline demographics and clinical characteristics very similar to the earlier study. From a decade ago, average age was about 67 largely managed Medicare, 82%. Carlson Co. Morbidity of 3.4. With all of the comorbidities, you really anticipate that impact wound healing and when you're going to use the durable N. P. W T. We saw hypertension, diabetes and academia vascular disease again very similar to the patients that we see and treat with negative pressure for the wound mix. In this study, about half of the patients actually had what I consider cute wounds, open wounds or non healing surgical wounds and then around 20% where the D. F. U S. And then pressure ulcers and then all other is everything else that might include amputation, flaps and graphs, etcetera. So here's a first look at the overall results, looking at the wound related costs and the total cost to treat across all time periods for all wounds in aggregate. So the blue bar at the bottom represents the wound related expenses for these patients, and the red is all other costs. And what this study found was that patients who received N P W T O at 30 to 37% higher wound related and total cost to treat versus N P W T K. We then looked at that across the key wound types that I mentioned here. I'm showing the four. Not surprisingly, the chronic wounds cost significantly more than the acute wounds, and diabetic foot ulcers are the most costly to treat. Thus, we give a lot of attention to our D a few patients and, most importantly, their wound related costs. At 12 months, we're actually about half of the total cost to treat these patients, and that could be due to the fact that these patients often have multiple wounds, or that the wounds are not all healing within 12 months or a combination of both. But what I thought was also interesting is on the non healing surgical wounds on the left bar. We actually see 11,000 to $17,000 of wound related costs for 12 months following these patients, which says to me that perhaps they should have used Incision 11 p w t in the inpatient studying to protect that surgical wound for these complex patients, and they might have been able to avoid some of these out of hospital expenses. So these again were all statistically significantly higher for patients who received N p W t o versus N P W T K. So now we're actually looking at the breakdown on the wound related costs or that blue bar. What are the cost? Elements that are driving the total wound related costs to be statistically significantly higher for patients receiving N p w t o at the very bottom bar in blue here. That's the cost of the investment that was actually spent on the N P W T therapy itself. So the unit, the rental unit, the canisters, the supplies And we saw that N P W t o despite a lower price point for the payer at a higher total cost or expense, statistically significantly higher across each time period. And then the other differences across all of the resources and resource categories used for M P W T o were statistically significantly higher. Obviously, the big cost buckets were skilled. Nursing facility. Future Inpatient Stays Home Health uh, the only two that were statistically significantly higher for the n p w t k category for er visits and physician office. But those were very small. In fact, on these graphs, they represent the red and the yellow bar, so you can see there are almost immaterial and the cost to treat so really across all categories, including the therapy and the device itself. The patients who received NVW Tito used more health care resources are required. More health care resources. This is just looking at N p W t. Utilization over time. So, for example, if you look at the month three bars at month 3 20% of the n p w T O patients were still on therapy versus 13% for M p W T K. So that basically means a longer average length of therapy for the patients on the competitor, uh, supplies. That also explains why, on the prior side we saw that the payer was actually spending more for M P W T O. Despite the fact that it's a lower price unit, it actually was used longer, thus the higher expense to the commercial payer. We also looked at some quality measures 30 day hospital admission, and we saw at 30 days post that e 242 or the negative pressure claim no statistically significant difference. Although I still think a 14% hospital admission rate within 30 days just points to how complex these patients are. We're receiving the durable MP W T. We also looked at switching rate, which is defined at he, um, the percent of patients that start on one m p w t category or start in one category and moved to the other category, and we looked at that at 30 days and three months and again we saw a statistically significant higher rate of switching for patients who received N P W T o. So, for example, on the right to bars there at three months. That 3.7% indicate that 3.7% of the patients who started on n p w t o switched to N P W t k statistically significantly higher, indicating some issue or uh need to switch between the two categories. In summary, the total cost to treat and the total wound related costs were 30 to 37% higher at all time periods for M P W T o versus M P W t k statistically significantly. So we saw that the cost on the therapy itself was higher across time periods for N P W T o versus M p W t k. We saw that more N p W T o patients had an M P W T claim in each subsequent month following that initial outpatient claim, which represented a longer average length of therapy for the patients on those devices, we saw no statistical difference in hospital admission. Within 30 days, we did see higher switching for patients who started on N P. W. T O. Within 30 days and at three months and then in general, N. P. W. T. Represented 3% of the total cost to treat at 12 months across. All wound types studied, so there are many limitations to claims data. Most importantly, when you're studying wounds, claims data did not include the age of the wound, a healing measure or the size of the wound at the start of treatment. And obviously we know that all of those impact wound healing. However, it does confirm that differences exist between the two cohorts in this patient population, which is similar to what we saw in our study back in 2013. And I think now, more than ever across all care settings, everyone is looking for quality wound care providers, partners and suppliers to help our patients with acute and chronic wounds heal effectively in the out of hospital setting. Thank you for joining me today. This publication is available for download free of charge on curious dot com. Thank you Published April 6, 2021 Created by Related Presenters Amy Law, MBA Global Health Economics, Outcomes Research and Market Access, 3M Medical Solutions Division
