A MEDICOECONOMIC STUDY OF VENOUS LEG ULCER TREATMENT - EARLY RESULTS

Purpose. There is little data on the different techniques used in Fran ce to treat venous leg ulcers. Due to the lack of a well-accepted stan dard, it is most likely that therapeutic attitudes vary greatly. An as sessment of the respective cost/benefit ratios would be most useful, b ut requires prior knowledge of the techniques used. We therefore condu cted a survey of the main management schemes applied in France. Patien ts and methods. A cross-sectional survey involved 800 investigators (8 5 % general practitioners, 15 % specialists: angiologists and dermatol ogists) throughout France. Each investigator was invited to include 2 patients with venous ulcerations of the leg. One patient was to have a long-standing ulceration (at least 6 weeks duration) and the other a new ulceration (less than 2 weeks duration). Patients were followed to cure or to study end-point six months after diagnosis, The clinical o bservations at inclusion are presented here for 247 patients with veno us ulcerations. Results. The patient population showed a clear predomi nance and advanced age (mean 72 years). In half of the cases, the diag nosis was made at a home visit and in 20 % of the cases at an office v isit for a reason other than leg ulceration. History taking revealed a high frequency of varicose veins, osteoarthritis of the lower limbs a nd high blood pressure as well as a high rate of recurrence (60 % for long-standing ulcerations). Treatments prescribed at the first visit w ere divided into 10 groups. The most frequently used methods were: cle ansing, contention and general therapy (antibiotics, anticoagulants, a ntiaggregates, analgesics). General practitioners focused primary trea tment on general therapies and local care while specialists used conte ntion more often (more than 90 %) and different Skin treatments. These different treatment combinations were then grouped into 7 main types of therapeutic attitudes, differentiating between general practitioner s and specialists. There were however three common elements found in t he treatments applied by more than 50 % of the physicians: cleansing ( 99 %), combined with contention (64 %) or a general therapy (56 %). Co nclusion. The main observation was that contention is used at a relati vely high percentage (77 %). This survey must be continued with a larg er number of inclusion visits and an analysis of follow-up visits in o rder to identify possible changes in therapeutic attitudes and the ass ociated costs as a function of treatment duration and rate of cure wit hin the 6 month period.