Burden of venous leg ulcers in the United States

Rice, J. Bradford; Desai, Urvi; Cummings, Alice Kate; Birnbaum, Howard G.; Skornicki, Michelle; Parsons, Nathan B.

doi:10.3111/13696998.2014.903258

Cited by 163 publications

(144 citation statements)

References 12 publications

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“…BLCC and HFDS patients were separately matched oneto-one to the CC patients (using a greedy matching method) 19 based on year of index, age (AE2 years), and the likelihood of being treated with BLCC/HFDS (AE¼ SD) as determined by propensity scores, which have been used extensively in prior wound care evaluations 7,[20][21][22][23] . Propensity scores were estimated using separate logistic regression models that accounted for differences in baseline characteristics across treatment groups, including patient-level demographics (gender and state), comorbidities, and wound severity, as well as physician-level experience measures (see Tables 1 and 2).…”

Section: Propensity Score Matchingmentioning

confidence: 99%

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

Rice

Desai

Ristovska

et al. 2015

Journal of Medical Economics

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Objective: To assess the real-world medical services utilization and associated costs of Medicare patients with diabetic foot ulcers (DFUs) treated with Apligraf (bioengineered living cellular construct (BLCC)) or Dermagraft (human fibroblast-derived dermal substitute (HFDS)) compared with those receiving conventional care (CC). Methods:DFU patients were selected from Medicare de-identified administrative claims using ICD-9-CM codes. The analysis followed an 'intent-to-treat' design, with cohorts assigned based on use of (1) BLCC, (2) HFDS, or (3) CC (i.e., !1 claim for a DFU-related treatment procedure or podiatrist visit and no evidence of skin substitute use) for treatment of DFU in 2006-2012. Propensity score models were used to separately match BLCC and HFDS patients to CC patients with similar baseline demographics, wound severity, and physician experience measures. Medical resource use, lower-limb amputation rates, and total healthcare costs (2012 USD; from payer perspective) during the 18 months following treatment initiation were compared among the resulting matched samples. Results:Data for 502 matched BLCC-CC patient pairs and 222 matched HFDS-CC patient pairs were analyzed. Increased costs associated with outpatient service utilization relative to matched CC patients were offset by lower amputation rates (À27.6% BLCC, À22.2% HFDS), fewer days hospitalized (À33.3% BLCC, À42.4% HFDS), and fewer emergency department visits (À32.3% BLCC, À25.7% HFDS) among BLCC/ HFDS patients. Consequently, BLCC and HFDS patients had per-patient average healthcare costs during the 18-month follow-up period that were lower than their respective matched CC counterparts (À$5253 BLCC, À$6991 HFDS). Limitations:Findings relied on accuracy of diagnosis and procedure codes contained in the claims data, and did not account for outcomes and costs beyond 18 months after treatment initiation. Conclusion:These findings suggest that use of BLCC and HFDS for treatment of DFU may lower overall medical costs through reduced utilization of costly healthcare services.

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Section: Propensity Score Matchingmentioning

confidence: 99%

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

Rice

Desai

Ristovska

et al. 2015

Journal of Medical Economics

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“…According to an analysis of Medicaid and Medicare data that included over 80,000 clients in the USA, venous leg ulcer patients incurred higher annual incremental medical costs compared to matched nonulcer patients. Venous ulcer patients reported more days missed from work [7]. Many patients living with chronic leg ulcers experience persistent pain and other disabling symptoms, psychosocial stress, depression, sleep disturbance, loss of employment, and physical disabilities contributing to diminished quality of life [8].…”

Section: Introductionmentioning

confidence: 99%

Management of Venous Stasis Ulcers in the Older Adult

Woo

LeBlanc

Livingston³

2015

Curr Geri Rep

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Venous stasis disease is common among older adults due to calf muscle pump failure, immobility, chronic edema, and obesity. Increased venous pressure increases the capillaries' permeability allowing fluid, proteins, and blood cells to leak into the tissues. Ulceration is precipitated by reduced oxygen diffusion to the skin and microvasculature damages. While most chronic leg ulcers are caused by venous stasis disease, there is a need to rule out other underlying pathologies including arterial, neuropathic, metabolic, hematological, infectious, malignant, and inflammatory diseases. Compression therapy with high stiffness index is the mainstay of treatment for venous leg ulcers. Adherence to compression therapy could be a challenge in the older population due to reduced dexterity, muscle strength, range of motion, and flexibility. Medications such as pentoxifylline, flavonoids, and zinc have been shown to have a positive role in the management of venous disease.

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“…Chronic venous ulcers pose a substantial threat to a patient's quality of life and the annual treatment and management of these wounds can be as much as $3 billion 3 , with additional indirect costs associated with limited productivity and mobility issues related to pain and depression 4 . Each year, over half a million people in the United States are affected by chronic venous ulcers, accounting for approximately 1% of the total health care cost and resulting in the loss of up to 2 million work days 5,6 .…”

Section: Introductionmentioning

confidence: 99%

20 kHz ultrasound assisted treatment of chronic wounds with concurrent optic monitoring

et al. 2015

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This paper describes a novel, wearable, battery powered ultrasound applicator that was evaluated as a therapeutic tool for healing of chronic wounds, such as venous ulcers. The low frequency and low intensity (~100mW/cm 2 ) applicator works by generating ultrasound waves with peak-to-peak pressure amplitudes of 55 kPa at 20 kHz. The device was used in a pilot human study (n=25) concurrently with remote optical (diffuse correlation spectroscopy -DCS) monitoring to assess the healing outcome. More specifically, the ulcers' healing status was determined by measuring tissue oxygenation and blood flow in the capillary network. This procedure facilitated an early prognosis of the treatment outcome and -once verified -may eventually enable customization of wound management. The outcome of the study shows that the healing patients of the ultrasound treated group had a statistically improved (p<0.05) average rate of wound healing (20.6%/week) compared to the control group (5.3%/week). In addition, the calculated blood flow index (BFI) decreased more rapidly in wounds that decreased in size, indicating a correlation between BFI and wound healing prediction. Overall, the results presented support the notion that active low frequency ultrasound treatment of chronic venous ulcers accelerates healing when combined with the current standard clinical care. The ultrasound applicator described here provides a user-friendly, fully wearable system that has the potential for becoming the first device suitable for treatment of chronic wounds in patient's homes, which -in turn -would increase patients' compliance and improve quality of life.

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Burden of venous leg ulcers in the United States

Abstract: These findings suggest an annual US payer burden of $14.9 billion.

Cited by 163 publications

References 12 publications

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

Management of Venous Stasis Ulcers in the Older Adult

20 kHz ultrasound assisted treatment of chronic wounds with concurrent optic monitoring

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