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Title: Informing coverage and reimbursement decisions of medical devices : evidence from acute wound care and musculoskeletal disorders
Author: Nherera, Leo
ISNI:       0000 0004 9354 4807
Awarding Body: Manchester Metropolitan University
Current Institution: Manchester Metropolitan University
Date of Award: 2020
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The burden of wounds and musculoskeletal (MSK) disorders are rising, primarily due to higher life expectancy and the growing epidemic of associated chronic diseases. This has made identifying technologies that can improve patient outcomes at the lowest cost possible an increasingly important pursuit. The aim of this thesis was to evaluate the clinical and economic evidence used to inform coverage and reimbursement decisions of medical devices using examples from wound care and MSK disorders. This thesis presents and offers a critique of 8 of my publications, which either updated, and or contributed to new knowledge in the field. The clinical effectiveness of wound and MSK disorders was explored via systematic literature reviews, meta-analysis, and indirect treatment comparison. The clinical evidence was then used to inform the cost-effectiveness analysis of these interventions in these patient populations. The result of the analyses assessed for this thesis demonstrate; that for burn wound care, ACTICOAT was the most cost-effective compared with other silver dressings, whereas the use of PICO negative pressure wound therapy following surgical incision was cost-saving from a payer’s perspective compared with standard care. Lastly, in MSK disorders, the use of twin-screw intramedullary nail InterTAN was found to be cost-saving from a payer’s perspective compared with single-screw nails in patients with unstable trochanteric fractures. Using examples of wound and MSK disorders, the thesis demonstrates that when clinical and cost-evidence are utilised, clinicians and payers are able to make decisions that optimise patients’ outcomes as well as their budgetary spend. This was illustrated in the United Kingdom’s National Health Service, where PICO negative pressure wound therapy was granted widespread coverage, and the South Korean Health authority granting a 10% price increase for InterTAN citing evidence presented in this iv thesis. The strengths and limitations of this thesis was highlighted and recommendations suggested for future research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available