Health Economics of Bacterial Fluorescence Imaging: Realized Cost Savings with Fluorescence Informed Sampling of Chronic Wounds

Introduction: More than $33 billion is spent annually on chronic wounds in the United States, leaving facilities and payers in search of key areas for cost reduction. A seminal article stated: “By questioning and justifying the need to sample and perform microbiological analyses on any problematic wound, long-term savings in cost, labor, and time to both the wound management team and the microbiology laboratory could be considerable.” This model assessed sampling-based cost savings from incorporation of bacterial fluorescing imaging (FL), which detects moderate-to-heavy bacterial loads in real time, into routine wound assessment.

Assumptions: Model assumed an average sampling cost of $250, as reported from CMS physician billed test payment. Cost increases would be incurred with the purchase of the device and use of an environment-darkening drape in 40% of cases.

Modeling: Ottolino-Perry et al. described the incidence of sampling in 27 wounds based on CSS compared to FL guidance. Some 66.7% of wounds would have been sampled based on CSS, and 40.7% of wounds would have been sampled based on fluorescence. The prevalence of moderate-to-heavy bacterial loads in those wounds was 44%. Extrapolating this to a typical wound care clinic with two clinicians seeing 25 patients per day, over three clinic days per week, an estimation of the annual lab costs was calculated.

Results: Fluorescence-informed sampling decisions in this extrapolated model would have eliminated 824 lab tests, resulting in a gross savings of $205,920. The net savings in the model were estimated to be $156,873, yielding a device “pay back period” of two months based on sampling cost reduction alone.

Conclusions: Real-time information on the presence and location of fluorescence from bacteria at moderate to heavy loads can decrease wound sampling rates, resulting in substantial cost savings.