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marketing authorisation route exists though national routes can still be followed. However individual EU countries will have very different approaches to estab­lishing health economics and reimbursement, perhaps even requiring additional clinical studies. Most will have Health Technology Assessment (HTA) bodies to assess these factors for their nations and whilst some harmonisation in approach occurs via the European Network for Health Technology Assessment (EUnetHTA) (Tafuri et al. 2020), and legislation is intended for 2025, national differences to reimbursement and health economic decisions undoubtedly occur. Examples of these HTA bodies in Europe are the French National Authority for Health (Haute Autorité de Santé), the UK National Institute for Health and Care Excellence (NICE) (Methods for the development 2012) the German Institute for Quality and Efficiency in Health Car e (IQWIG). Interestingly the US lacks a single HTA approach perhaps due to its decentralised insurance system, where each priva te and public payer makes individual decisions and conducts its own negotiations with manufacturers.

the use of cupping and also post surgical wound drainage via hospital suction such as that described by Chariker in 1989 (Chariker 1989). The translational need was how to make NPWT available in the most reliable and repeatable manner to the widest number of users. The VAC device (KCI Medical Ltd) was launched in the 1990s bringing together the key elements of NPWT envisaged by the clinical innovators such as Dr Louis Argenta and Dr Michael Morykwas of Wake Forest University. These elements were the use of a suction device/pump, a filler/dressing and tubing leading to a canister. KCI developed these components as medical devices and had the system registered using the processes described earlier as an off the shelf medical device ( or combination of devices) that could be used ( for purchase or rental) by clinicians. The clinical impact that NPWT had on a range of wounds was significant (Novak et al. 2014) and initially was demonstrated in acute wounds, allowing its use in hospitals where acute facilities could choose to adopt and pay for this therapy based on the demonstrated cost savings compared with alternative dressing regimens. However, its use in the community and homecare took several years to be reimbursed (and even then initially only in the US). This was despite the ever growing demand for home‐based care from the Healthcare system and a wish to reduce the unnecessary burden on hospital beds which NPWT in the home could help support (Trueman 2008). Furthermore its value in chronic wounds, largely treated in the community, became apparent. The reimbursement position in Europe for example remains even now very complex varying among coun­tries and also regions in countries. This lag or even refusal of reimbursement between regions and countries is due to the differing economic assessment processes or evidence needs overlaid on the structure of the healthcare system for homecare patients across countries. In each country the patients largely present the same with common needs and harmonised regulatory approvals for products in place.

appointed head of this team and from over 2000 Chinese TCM recipes screened, they identified a potent and active extract from the plant sweet wormwood (Artemisia Annua) (Valavanidis 2019). They developed, using ethanol, a specialised extraction process which allowed retention of the active properties and isolated what became named as artemisinin. It was discovered during the “cultural revolution” at a time when fields of research in China were limited and publication in foreign journals was not allowed. Despite difficulties in getting the therapy progressed to human trial, it was ultimately shown to be a highly safe and effective treatment. Gaining wider global access or awareness of artemisinin was also challenging however once it did then it rapidly became an important part of the armamentarium of malaria treatmen ts firstly in China then more globally. The parasite had by this time begun to show resistance to existing drugs and it was further demonstrated that a rtemisinin or its derivatives when used in combination with other treatments such as lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine and chlorproguanil/dapsone was highly effective against drug resistant malaria and quickly became the first line therapy of choice popularly known as Artemisinin combination therapy (ACT). These therapies continue to be improved (Lyu 2021;Tu2016). What can we learn from this case study in relation to wound healing? Firstly, in looking for solutions to clinical problems we need to be open minded to translate possible therapies from a wide variety of sources such as traditional Chinese medicine and proven practice. Secondly, as with the NPWT case, then often to achieve a successful clinical end point perhaps a number of existing known approaches will need to be combined to achieve a solution that will be clinically successful and the idea of “combination” approaches is a powerful one as demonstrated here. There can be few translational medical innovations that have had as much impact as this one and it demonstrates that “discovery”—the process of finding or learning rather than creating and inventing—is as relevant and important in human health as creating new to the world solutions.