Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study

Venous stasis ulcers (VSU) account for approximately 80-90% of lower extrem ity ulcerations. Given their prevalence and chronic nature, VSU are thought to impose a significant economic burden on Medicare (the USA's largest hea lth insurance program) and other third party payers, However, comprehensive studies on the costs of VSU treatment are lacking. The objective of this s tudy therefore was to examine comprehensively the direct medical costs of t reating patients with a VSU in routine clinical practice. A cohort of 78 patients who presented with a VSU to the Cleveland Clinic Fo undation (CCF), a large primary and tertiary referral center, was studied r etrospectively. All inpatient and outpatient costs related to VSU treatment that were incurred during the year following VSU presentation or until the ulcer healed, whichever occurred first, were quantified. A total of 71 (91 %) patients healed during the study. The average duration of follow-up was 119 days (median: 84 days). The average number of visits per patient was se ven (range: 2 to 57). A total of 14 (18%) patients underwent 18 hospitaliza tions for VSU care. The average total medical cost per patient was $9685 (m edian: $3036), Home health care, hospitalizations and home dressing changes accounted for 48%, 25% a nd 21% of total costs, respectively. Total costs were related to duration of active therapy, ulcer size and the presence of at least one comorbidity (p<0.05). VSU are costly to manage, especially when time to healing is prolonged. The present findings reflect an underestimate of VSU costs since indirect cost s were not examined. Time absent from work, forced early retirement, loss o f functional independence and unquantifiable suffering may be additional fa ctors that contribute to the overall burden of VSU.