Master assignment Wound Care in MST

Healthcare costs in “hard-to-heal wounds”.

Analysis of current situation and potential improvements in quality of care and costs

Hard-to-heal wounds are those wounds that do not heal within 2-3 weeks despite adequate local wound treatment. In most cases there is an underlying disease, like diabetes mellitus, peripheral arterial occlusive disease or venous leg ulcers. Current studies suggest that 2% of the Dutch population has such wounds. This number is rising due to ageing and the increasing number of patients with diabetes. For instance, at this moment there are over 1 million patients with diabetes in the Netherlands and every week there are 1000 more patients with diabetes. Over 50% of the diabetic patients will have a diabetic foot ulcer in their life.

The costs of treatment of patients with hard-to-heal wounds is impressive. Previous analyses suggest that the cost in wound care is 5% of the total healthcare cost in the Netherlands. These costs can be divided in costs related to hospitable care, primary care, home care and dressings.

The current situation of wound care in the Netherlands is as follows. A patient with a wound usually visits the family physician and in most cases treatment is performed by home care nurses. A recent study in Twente showed that many patients are “treated” this way for over 30 weeks before they are send to a hospital wound care unit for further treatment. Experts in wound care have suggested that wound healing could be much faster if patients are referred to a specialized wound unit within 3 weeks. Treatment of the underlying cause why wounds do not heal, e.g. ischemia, might indeed lead to faster wound healing and may help in lowering costs related to wound healing.

Several measures are taken in the Netherlands to improve quality of wound care and lower costs in wound treatment. Specialized wound care units are now available in many hospitals. In the Medisch Spectrum Twente we recently started with a specialized wound care unit, led by surgeons, reconstructive surgeons and dermatologists. At this moment we are in discussion with primary care and home care institutions to make further improvements in the wound care, such as early referral and improving wound care knowledge in home care. Whether such changes in wound care will decrease total costs in wound care is unknown.

Recently, data from two insurance companies (CZ and Friesland verzekeringen) got available for analysis of cost related to wound care. Also the data from several wound care units in the Netherlands are available for further analysis of patient characteristics and healthcare costs. Finally we have started to analyse new technologies for wound treatment like Google-glass and the electronic nose.

In the master project we have the following questions:


How many patients have a hard-to-heal wound and what is the relationship to disease known to lead to wounds?


What are the exact costs of wound care at this moment?


Analyse potential improvements in organization of wound care and assess effect on costs in wound care.


Start with an analysis of new imaging and intervention technologies that may improve wound care.

The project will be supervised by:

Robbert Meerwaldt, vascular surgeon MST and chairman dutch guideline complexwound care

Rens van Liere, business economist Excen BV

Roland Beuk, vascular surgeon MST

Marjan Hummel, assistant professor DeciDE University Twente