Subfascial Endoscopic Perforator Surgery is More Cost-Effective Than Compression Bandaging for Healing Venous Ulcers

Abstract

Objective: To determine whether subfascial endoscopic perforator surgery (SEPS) is more cost-effective than compression bandaging for healing venous ulcers. Design: Cost analyses based on theoretical patients supposing the two methods are equally effective in healing venous ulcers. Setting: District hospital. Patients: A theoretical population of 200 patients with unilateral leg ulceration due to incompetent perforating veins. Intervention: The cost of SEPS was calculated based on outpatient visits, investigations and surgery including complications, with varying failure and re-ulceration rates. The cost of compression bandaging was estimated from published data and compared with that of SEPS. Results: The average cost per patient undergoing SEPS was £723. In 100 patients with an operative failure rate of 2% and a 10% re-ulceration rate, the cost increased to £818/patient in the first year (£16/ulcer-free week). A re-ulceration rate of 35% increased the cost to £23/ulcer-free week. However, the cost of compression bandage was £33/ulcer-free week using the same model, with healing rates of 50–70% at 20–40 weeks and a recurrence rate of 18–30% at 30–40 weeks. Conclusion: In a theoretical model SEPS was more cost-effective in healing venous ulcers due to incompetent perforators compared with compression bandaging.