Health Economics of Fluorescence Imaging: Realized Cost Savings with Appropriate Treatment of Bacteria in Chronic Wounds

Abstract Body: Introduction: More than 33 billion dollars is spent annually on chronic wounds in the United States, leaving facilities and payers in search of key areas for cost reduction. Under treatment and over treatment are both examples of sub-optimal wound care that grossly inflate costs. This model evaluated under and over treatment based on reported diagnostic accuracy of standard of care assessment compared to incorporation of bacterial fluorescence imaging, which detects moderate-to-heavy bacterial loads in real time. Assumptions: Model assumed: (1) 3% prevalence of true positive wound infection, (2) $2164 average cost to treat a non-infected wound, and (3) $6717 to treat an infected wound, all calculated from CMS 2014 data1. Cost increases would be incurred with the purchase of the device and use of an environment darkening drape in 60% of cases. Modeling: Sibbald & Woo reported sensitivity/specificity of clinical signs and symptoms as (81%/74%)2. Fluorescence-guidance has a reported sensitivity/specificity of (100%/78%)3. Based on how those metrics influence treatment decisions, proportions of under or over-treatment instances were predicted. Extrapolating this to a typical wound care clinic 2 days/week seeing 40 patients per day, an estimation of the annual budget impact was calculated. Results: Superior sensitivity of fluorescence-informed treatment decisions reduced under treatment, with cost savings $136,521. Over treatment was also reduced, saving $9259. Accounting for device cost and conservatively assuming 10% of wounds could be influenced in this manner, the net annual savings in the model were estimated to be $10,783 USD, yielding a device “pay back period” of 10 months. Conclusions: Real-time information on the presence and location of fluorescence from bacteria at moderate-to-heavy loads can reduce under and over treatment of wounds, resulting in substantial cost savings.