Leg Ulcers: Economic Aspects

Abstract

Objective: To review what is known about the cost of leg ulcers, and venous leg ulcers in particular. Method: Searches of the Medline and Cochrane Library databases. Reviewing reference lists of personally gathered articles in the field of chronic leg ulcers. Synthesis: Most publications dealing with the economics of leg ulcers are cost studies assessing the cost of different dressings or bandages, and only a few have given estimates of the total costs of leg ulcer management. The latter, in conjunction with accurate epidemio-logical data, are essential to estimate the nationwide costs of leg ulcer management. The costs consist of direct and indirect costs for society. Direct costs are mainly staff costs for managing dressing-changes. Based on the few estimates made, approximately 1% of the total health care costs in the western world are likely to be used for management of chronic leg ulcers. To reduce the costs of leg ulcer management a reduction in the frequency of dressing-change is recommended. Improved use of high technology, such as duplex Doppler diagnostics and varicose vein surgery, is also likely to be cost-effective. On the basis of two health economic analyses leg ulcer clinics alone do not appear to reduce the costs of leg ulcer management, mainly because of an inability to prevent recurrent ulceration. Conclusion: The cost implications of chronic leg ulcers are insufficiently studied but there is no doubt that managing patients with leg ulcers takes a substantial proportion of the health care budget. More health economic analyses are needed to define the best treatment in order to reduce total costs.