Cost of managing patients with venous leg ulcers

Ceri J Phillips, Ioan Humphreys, Dan Thayer, Muhammad Elmessary, Huw Collins, Chris Roberts, Gurudutt Naik, Keith Harding, Ceri J Phillips, Ioan Humphreys, Dan Thayer, Muhammad Elmessary, Huw Collins, Chris Roberts, Gurudutt Naik, Keith Harding

Abstract

The aim of this study was to estimate costs associated with the management of patients with venous leg ulcers (VLUs) from the perspective of the UK National Health Service (NHS). The analysis was undertaken through the Secure Anonymised Information Linkage Databank which brings together and anonymously links a wide range of person-based data from around 75% of general practitioner (GP) practices within Wales (population coverage ~2.5 million). The data covered an 11-year period from 2007 to 2017. All patients linked to the relevant codes were tracked through primary care settings, recording the number of GP practice visits (number of days with an event recorded), and wound treatment utilisation (eg, dressings, bandages, etc.) Resources were valued in monetary terms (£ sterling) and the costs were determined from national published sources of unit costs. This is the first attempt to estimate the costs of managing of VLUs using routine data sources. The direct costs to the Welsh NHS are considerable and represent 1.2% of the annual budget. Nurse visits are the main cost driver with annual estimates of £67.8 million. At a UK level, these costs amount to £1.98 billion. Dressings and compression bandages are also major cost drivers with annual Welsh estimates of £828 790. The direct cost of managing patients with VLUs is £7706 per patient per annum, which translates to an annual cost of over £2 billion, when extrapolated to the UK population. The primary cost driver is the number of district nurse visits. Initiatives to reduce healing times through improving accuracy of initial diagnosis, and improved evidence-based treatment pathways would result in major financial savings.

Keywords: VLUs; chronic wounds; economic burden; linked routine data.

Conflict of interest statement

The study's sponsors had no involvement in the study design; the collection, analysis, and interpretation of the data and methodology; the writing of this manuscript; and the decision to submit this article for publication. The views expressed in this article are those of the authors and not necessarily those of the sponsors. The authors have no conflicts of interest with this study.

© 2020 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

References

    1. Nelzen O, Bergqvist D, Lindhagen A. Venous and non‐venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994;81:182‐187.
    1. Sadler GM, Russell GM, Boldy DP, Stacey MC. General practitioners' experiences of managing patients with chronic leg ulceration. Med J Aust. 2006;185:78‐81.
    1. Bergan JJ, Schmid‐Schonbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355:488‐498. 10.1056/NEJMra055289.
    1. Margolis DJ, Bilker W, Santanna J, Baumgarten M. Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol. 2002;46:381‐6.3.
    1. White JV, Ryjewski C. Chronic venous insufficiency. Perspect Vasc Surg Endovasc Ther. 2005;17:319‐27.2.
    1. Couzan S, Leizorovicz A, Laporte S, et al. A randomized double‐blind trial of upward progressive versus degressive compressive stockings in patients with moderate to severe chronic venous insufficiency. J Vasc Surg. 2012;56:1344e1‐50e1. 10.1016/j.jvs.2012.02.060.5.
    1. Pfisterer L, Konig G, Hecker M, Korff T. Pathogenesis of varicose veins—lessons from biomechanics. Biomech varicosis. 2014;43:88‐99. 10.1024/0301-1526/a000335.6.
    1. Beebe‐Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epi‐demiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:175‐184. 10.1016/j.annepidem.2004.05.015.
    1. Green J, Jester R. Health‐related quality of life and chronic venous leg ulceration: Part 2. Br J Community Nurs. 2010;15:S4‐S6. 10.12968/bjcn.2010.15.Sup1.46906.
    1. Maddox D. Effects of venous leg ulceration on patients' quality of life. Nurs Stand. 2012;26:42‐49. 10.7748/ns2012.05.26.38.42.c9111.
    1. Guest JF, Vowden K, Vowden P. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017;26:292‐303. 10.12968/jowc.2017.26.6.292.
    1. Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):29‐37. 10.1111/iwj.12814.
    1. SAIL Databank . (accessed October 2018)
    1. Lyons RA, Jones KH, John G, et al. The SAIL databank: linking multiple health and social care datasets. BMC Med Inform Decis Mak. 2009;9:3. .
    1. Ford DV, Jones KH, Verplancke JP, et al. The SAIL Databank: building a national architecture for e‐health research and evaluation. BMC Health Services Res. 2009;9:157 .
    1. British National Formulary (BNF). . Accessed October 2018.
    1. Personal Social Service Research Unit (PSSRU) . . Accessed October 2018.
    1. NHS Wales Informatics Service. . Accessed October 2018.
    1. Welsh Government (Statistics) . . Accessed October 2018.
    1. Primary Care Services Wales NHS. ‐prescribing‐data‐extrac. Accessed October 2018.
    1. Hobbs DR, Bankhead C, Mukhtar T, et al. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet. 2016;387:2323‐2330. .
    1. Hippisley‐Cox J, Vinogradova Y. Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009. Analysis of the QResearch database.
    1. Personal Social Service Research Unit (PSSRU) . 2015. . Accessed October 2018.
    1. Phillips CJ, Humphreys I, Fletcher J, et al. Costs associated with the management of patients with chronic wounds using linked routine data. Int Wound J. 2016;13(6):1193‐1197.
    1. Lindholm C, Searle R. Wound management for the21st century: combining effectiveness and efficiency. Int Wound Journal. 2016;13:5‐15. 10.1111/iwj.12623.
    1. Moffatt CJ, Edwards L, Collier M, et al. A randomised controlled 8 week cross‐over clinical evaluation of the 3M Coban 2 layer compression system versus Profore to evaluate product performance in patients with venous leg ulcers. Int Wound J. 2008;5(2):267‐279.
    1. Aitkin L, Bucko C, Montero C, et al. Implementing TIMERS; the race against hard to heal wounds. J Wound Care. 2019;28(3 Suppl):S1‐S49.
    1. Gohel M, Heatley F, Liu X, et al. A randomised trial of early endovenous ablation in venous ulceration. New Eng J Med. 2018;378:2105‐2114.
    1. Roberts CD, Windsor PA. Innovative pain management solutions in animals may provide improved wound pain reduction during debridement in humans: an opinion informed by veterinary literature. Int Wound J. 2019;16(4):968‐973. 10.1111/iwj.13129.

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