Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study

Abstract

Venous stasis ulcers (VSU) account for approximately 80-90% of lower extremity ulcerations. Given their prevalence and chronic nature, VSU are thought to impose a significant economic burden on Medicare (the USA's largest health insurance program) and other third party payers. However, comprehensive studies on the costs of VSU treatment are lacking. The objective of this study therefore was to examine comprehensively the direct medical costs of treating patients with a VSU in routine clinical practice. A cohort of 78 patients who presented with a VSU to the Cleveland Clinic Foundation (CCF), a large primary and tertiary referral center, was studied retrospectively. All inpatient and outpatient costs related to VSU treatment that were incurred during the year following VSU presentation or until the ulcer healed, whichever occurred first, were quantified. A total of 71 (91%) patients healed during the study. The average duration of follow-up was 119 days (median: 84 days). The average number of visits per patient was seven (range: 2 to 57). A total of 14 (18%) patients underwent 18 hospitalizations for VSU care. The average total medical cost per patient was $9685 (median: $3036). Home health care, hospitalizations and home dressing changes accounted for 48%, 25% and 21% of total costs, respectively. Total costs were related to duration of active therapy, ulcer size and the presence of at least one comorbidity (p<0.05). VSU are costly to manage, especially when time to healing is prolonged. The present findings reflect an underestimate of VSU costs since indirect costs were not examined. Time absent from work, forced early retirement, loss of functional independence and unquantifiable suffering may be additional factors that contribute to the overall burden of VSU.

Low-frequency (&lt;100 kHz), low-intensity (&lt;100 mW/cm2) ultrasound to treat venous ulcers: A human study and in vitro experiments

“…Multiple factors contribute to the delayed healing of venous ulcers including ambulatory venous hypertension often associated with venous reflux, poor nutrition, advancing age, smoking, and medical compliance (i.e., following physician's guidelines and recommendations) (Gohel et al, 2005). The direct wound care cost associated with venous ulcers exceeds $2400 per month, but also is associated with indirect costs due to limited productivity and quality of life issues related to pain and depression (Olin et al, 1999). New therapies are needed to both directly help patients and to decrease the costs related to these wounds.…”

Refractory ulcers: The role of tumor necrosis factor–α

“…7 The annual cost of treating these chronic wounds is several billion dollars. 8,9 In addition to a diminished quality of life of affected individuals, pressure, diabetic, and arterial ulcers are associated with increased mortality. [10][11][12] Lately, much research has focused on the prolonged inflammatory phase in nonhealing wounds, especially the potential role of the normally regulated tissue necrosis factorealpha (TNF-a).…”

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

“…PTS has also been shown to lead to venous leg ulcers that are difficult to treat and that often recur. The direct medical costs of treating PTS and the indirect costs of the related work disability have been shown to result in substantial economic burden to the health care systems of several North American and European countries (10)(11)(12)(13).…”