More economic evaluations are needed in calculating the burden of wound care

Dear Editors,

We read with interest the 5‐year institutional population health review by Zhiwen et al who evaluated the clinical and economic burden of wound care in the Tropics. They reported that the clinical and economic burden of wound care in the tropics had a clear and rising trend, and the average total cost per wound attack in 2017 was $12 967. ¹ However, we believe that a more comprehensive analysis is needed to assess the economic burden of disease.

First, we think that the author can calculate the cost in more details to achieve the purpose of rational use of medical resources. The authors did not explicitly indicate the type of cost when calculating economic burden. This may underestimate the economic burden of the disease. In the cost of disease, the total cost of medical care is divided into three categories: direct cost, indirect cost, and intangible cost. ² Direct costs generally include direct medical costs such as medicine, surgery, diagnosis and treatment, and nursing costs, as well as direct nonmedical costs such as transportation, room, and board. Direct medical costs and indirect costs account for a significant proportion of the total cost of the entire country. ³ The loss of working time due to illness and disability, as well as the loss of productivity, including capital losses caused by suspension of school, illness, and premature death constitutes indirect costs. The physical and mental pain of pain, anxiety, and tension caused by illness constitutes hidden costs. The intangible data can be collected by using contingent valuation techniques to record willingness to pay. ⁴

Second, it would be better if the author could study the economic burden of disease from a social perspective. For a long time, there has been a clear lack of accurate data on wound care, and the lack of such data may lead to a waste of medical resources. There is no authoritative economic analysis of chronic wounds. Patients with chronic wounds often have poor health‐related quality of life and high wound‐related costs. There is an urgent need to develop and implement wound management strategies with the goal of improving health‐related quality of life and effectively reducing the cost of this patient population. ⁵ The authors can conduct further economic evaluations, such as cost‐effectiveness analysis (CEA) or cost‐benefit analysis (CBA). Compare the differences among the treatments and choose more effective treatment options to reduce the burden on patients and treatment costs. CEA is currently the most commonly used economic evaluation method in the world. It uses the quality‐adjusted life years (QALYs) of two treatment schemes as indicators of health effects. ⁶ Incremental cost‐effectiveness ratio (ICER) can be used as the evaluation index for evaluation to indicate that the cost required for each additional QALY is increased. And then compare ICER with threshold criteria to determine the best treatment option.

In conclusion, because of mentioned issues, the total cost or economic burden of these two dialysis methods is in doubt.