COST EFFECTIVENESS ANALYSIS OF SYSTEMATIC REFERRAL TO MULTIDISCIPLINARY WOUND CARE TEAMS IN ONTARIO. EVIDENCE FROM THE WOUND INTERDISCIPLINARY TEAMS (WIT) TRIAL
Methods: We conducted cost-effectiveness and cost-utility analyses from the perspective of the Ontario Ministry of Health and Long-term Care. We compared the two strategies evaluated in the WIT trial: systematic referral to MDWCTs, and usual care. Patient-level data on effectiveness and resource utilization from the WIT study were used to estimate the incremental cost 1) per patient discharged from a Community Care Access Centre (CCAC) and 2) per quality adjusted life year (QALY) gained in the intervention compared to the control group over the 6-month period of the trial. Costs were estimated using chart reviews and monthly patient cost surveys. All costs are reported in 2012 Canadian dollars without discounting due to the short study period. Utilities were measured using the EQ-5D instrument. Cumulative costs and QALYs for both strategies were estimated using inverse probability weighting (IPW) methods to account for censoring.
Results: The analysis included 193 and 204 subjects with the total cost per subject of $2666 and $2992 from the control and intervention groups respectively. The proportion discharged and the total QALYs were 86.7% and 0.3324 QALYs in the control group and 85.1% and 0.3321QALYs in the intervention group. The incremental cost was $421 (95% CI: -$302, $1145). The difference in the proportion of subjects discharged was -0.02 (95% CI: -0.10, 0.06) and in QALYs gained was -0.009 (95% CI: -0.027, 0.009). The incremental net monetary benefit of intervention versus control was -$871 (95% CI: -$2012, $270).
Conclusion: Systematic referral to multi-disciplinary wound care teams did not appear to have a significant effect on either costs or health outcomes. Lack of significant findings might be partially due to the pragmatic nature of the RCT and inclusion of subjects with different wound etiologies in different care settings with insufficient power for subgroup analyses.