Venous leg ulcer management in clinical practice in the UK: costs and outcomes

Abstract

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing venous leg ulcers (VLUs) in clinical practice by the UK's National Health Service (NHS) and the associated costs of patient management. This was a retrospective cohort analysis of the records of 505 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015/2016 prices. Overall, 53% of all VLUs healed within 12 months, and the mean time to healing was 3·0 months. 13% of patients were never prescribed any recognised compression system, and 78% of their wounds healed. Of the 87% who were prescribed a recognised compression system, 52% of wounds healed. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 30% of all the VLUs may have been clinically infected at the time of presentation, and only 22% of patients had an ankle brachial pressure index documented in their records. The mean NHS cost of wound care over 12 months was an estimated £7600 per VLU. However, the cost of managing an unhealed VLU was 4·5 times more than that of managing a healed VLU (£3000 per healed VLU and £13 500 per unhealed VLU). This study provides important insights into a number of aspects of VLU management in clinical practice that have been difficult to ascertain from other studies and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.

Keywords: Burden; Cost; UK; Venous leg ulcers; Wounds.

© 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

Figure 1

Wound healing.

Figure 2

Kaplan–Meier time‐to‐healing analysis for patients who were and were not prescribed a recognised compression system. The healing distribution between the two groups was significantly different [Log Rank (Mantel–Cox): P < 0.0001].

Figure 3

Kaplan–Meier time‐to‐healing analysis for patients who were and were not prescribed analgesics. The healing distribution between the two groups was significantly different [Log Rank (Mantel–Cox): P = 0.0001].

Figure 4

Kaplan–Meier time‐to‐healing analysis for patients who were and were not prescribed anti‐infectives. The healing distribution between the two groups was significantly different [Log Rank (Mantel–Cox): P = 0.0001].

Figure 5

Monthly National Health Service cost of wound care at 2015/16 prices.