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Ökonomische Aspekte in der chirurgischen Wundbehandlung

Economic aspects of surgical wound therapies

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Zusammenfassung

Hintergrund

In Deutschland wenden die Krankenversicherungen derzeit alleine für die Behandlung des Dekubitus, der diabetischen Fußulzera und Ulcera cruris pro Jahr rund 5 Mrd. Euro nur an Sachkosten auf. Vor diesem Hintergrund sind Überlegungen zur ökonomischen Bedeutung der Wundbehandlung dringend erforderlich.

Methoden

Aufgrund der mangelnden evidenzgesicherten Datenlage zur Ökonomie der Wundbehandlung wird beispielhaft anhand klinischer Studien untersucht, welche Kostenrelevanz sich durch eine Umstellung von Feuchtverbänden auf andere Therapieansätze ergeben würde. Die geeigneten medizinischen Parameter werden jeweils mit den anfallenden Behandlungskosten bewertet und miteinander verglichen.

Ergebnisse

Anhand der bisher publizierten Daten können unterschiedliche Therapieansätze im Einzelfall zu einem frühzeitigeren Wundschluss mit reduzierter Komplikationsfrequenz, Verringerung von Krankenhauseinweisungen und Reduktion von Krankenhausverweiltagen führen. Trotz häufig erhöhter Tagesbehandlungskosten ergeben sich auf Grundlage solcher Daten Kostenvorteile im Vergleich zu anderen Therapiemodalitäten.

Schlussfolgerung

Obwohl aufgrund zahlreicher Faktoren wie variabler Komorbiditäten und häufiger Multimorbidität bei problematischen Wunden derzeit nur eine unzureichende Evidenz für die Effektivität und Effizienz verschiedener Modalitäten existiert, zeigt bereits die kritische Evaluation eines einzigen innovativen Therapieverfahrens im Vergleich zur Standardbehandlung, dass ein bei vordergründiger Betrachtung scheinbar teures Therapieverfahren im Einzelfall und in einem größeren ökonomischen Zusammenhang teils enorme Einsparpotenziale in sich bergen kann. Wichtig ist, die konservativen Behandlungsstrategien in operative chirurgische Konzepte einzubetten.

Abstract

Introduction

Health care insurers in Germany pay 5 billion Euros annually in materials alone for pressure ulcers, diabetic foot ulcers, and ulcus cruris. With such figures it is necessary to consider, economic aspects of treatment.

Methods

Due to the lack of evidence-based data on wound treatment costs, we investigated available studies for an effect on treatment costs when standard moist wound therapy was compared with alternative methods. Suited medical parameters are calculated and compared. Daily costs and length of treatment are correlated and compared.

Results

Published data show that alternative wound therapies may lead to an earlier wound closure, fewer complications, and reduction in hospital admissions and length of stay. Despite higher daily costs, some alternative wound therapies turn out to be more cost effective, when all economical factors are considered. In this respect a move towards alternative wound therapies could possibly lead to major savings.

Discussion

At present there is insufficient evidence to prove the efficacy of various treatment modalities for chronic wounds. This is due to numerous factors such as comorbidities and frequent multimorbidity. Nevertheless critical evaluation of one innovative treatment alone already uncovered an enormous potential for savings in a wider economic context, despite the comparatively higher cost of a single treatment. It is of utmost importance that conservative wound care become firmly embedded in surgical concepts.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Für diese Arbeit wurden keinerlei Zuwendungen oder Unterstützungen durch die Industrie erhalten. Die Autoren wurden für Vorträge auf Kongressen durch Reisekostenübernahmen, Honorare für Vorträge u. a. in der Vergangenheit durch die Fa. KCI, Wiesbaden unterstützt; REH und ML erhalten Drittmittel von KCI USA für experimentelle Untersuchungen zu molekularen Wirkungsmechanismen der Vakuumtherapie

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Authors and Affiliations

  1. Plastische und Handchirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    R.E. Horch, M. Leffler & A. Dragu

  2. Universität Konstanz, Konstanz, Deutschland

    D. Nord

  3. UKE - Klinik und Poliklinik für Dermatologie und Venerologie, FG Gesundheitsökonomie, Hamburg, Deutschland

    M. Augustin

  4. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie / Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland

    G. Germann

Authors
  1. R.E. Horch
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  2. D. Nord
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  3. M. Augustin
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  4. G. Germann
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  5. M. Leffler
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  6. A. Dragu
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Corresponding author

Correspondence to R.E. Horch.

Additional information

Herrn Prof. Dr. Dr. h.c. Werner Hohenberger zum 60. Geburtstag gewidmet.

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Horch, R., Nord, D., Augustin, M. et al. Ökonomische Aspekte in der chirurgischen Wundbehandlung. Chirurg 79, 518–525 (2008). https://doi.org/10.1007/s00104-008-1500-3

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