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 the incorporation of bacterial fluorescing imaging (FL; MolecuLight i:X; MolecuLight, Toronto, ON, Canada), 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 the Centers for Medicare & Medicaid Services 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 with 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 FL. The prevalence of moderate-to-heavy bacterial loads in those wounds was 44%. Extrapolating this to a typical wound care clinic with 2 clinicians seeing 25 patients per day over 3 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 2 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.

*This poster won 1st place in the Health Economics Category at the 2019 Symposium on Advanced Wound Care Fall.

Additional Oral and Poster Abstracts are Available on the Wound Care Learning Network.