Management of venous leg ulcer by French physicians, diversity and relatedcosts: a prospective medicoeconomic observational study

Objectives: The purpose of this study was to better ascertain how French ph ysicians manage venous ulcers of the lower limbs. We explored the various t herapeutic approaches used and their respective costs. Particular attention was focused on dressing prescriptions. Material and methods: A prospective medicoeconomic study was conducted. Eig ht hundred general practitioners and specialists throughout France were inc luded and followed two patients each, one with a "new ulcer" (less than two weeks) and another with a "longstanding ulcer" (more than six weeks). Pati ents were followed to healing or for up to six months. An observation chart was completed at each visit. Data collected were characteristics of the ul cer at inclusion, assessment of the clinical course, and the nature and the volume of medical care prescribed. Corresponding costs (total cost for the society) were calculated on the basis of 1996 public prices for drugs and the French national health insurance quotations for ambulatory care. For ho spital care, cost was calculated from the cost of stay for homogeneous pati ent groups. Results: Files established for 1,098 patients by 652 physicians could be as sessed. Elderly female patients predominated in this population (mean age 7 2 years, 74% women). The length of the ulcer at inclusion was significantly correlated with its duration: 2.82 cm for new ulcers (52.6% of the cases) versus 5.03 cm for longstanding ulcers (47.3%). The mean number of consulta tions for all patients was 4.5 over a 29-day period. Mean cost resulting fr om these consultations was 5,827 FF per patient (table I): 48% for care, 33 for drugs, 16% for hospitalizations, and 3% for work lap-off (fig. 1). Cur e was achieved in 77% of the cases within a mean delay of 3 months (table I I). Older ulcer was significantly associated with longer important (117 day s for longstanding ulcers versus 80 days for new ulcers), lower cure rate ( 67% versus 86%) and higher cost (7 078 FF versus 4 669 FF). Dividing care m ethods between those using cleaning with compression or not showed that com pression was prescribed in 76% of the cases at the inclusion consultation. This predominance of compression therapy did not preclude use of a variety of other therapeutic methods (table III) depending on the clinical and demo graphic situation of the patient. Cost varied accordingly with a mean rangi ng from 3 160 FF to 6 697 FF depending on the therapeutic attitude (table I V). The study also focused on the type and amount of dressings used. Dressi ngs were prescribed for 56 patients in this series. It can be hypothesized that these patients already had dressings. Different indicators show that t he absence of prescriptions for dressings concerned less severe and less co stly ulcers (4 130 FF Versus 5 918 FF for those with dressing prescriptions ). Among the 1 042 patients for whom dressings were prescribed, 35% were fo r occlusive dressings, 29% for ointment dressings and also 24% for both occ lusive and ointment dressings. The type was not specified in 55% of the cas es. Mean cost for these different categories ranged from 4 921 to 7 019 FF.