THERAPEUTIC APPROACHES OF FRENCH PHYSICIANS
TO VENOUS LEG ULCERS: DIVERSITY AND ENSUING COSTS.
ANALYSIS OF AN OBSERVATIONAL PROSPECTIVE MEDICO-ECONOMIC STUDY.
Levy E, Levy P. J Mal Vasc. 2001;26:39-44.
Article analyzed by Henri BOCCALON. The economic study is of interest in that it only takes into
CHU Rangueil-Toulouse account data obtained during the period of observation. In
particular, "old" ulcers had been in existence for an unknown
The objective of this observational prospective study was to length of time, for which no account of cost was included in
help to reach a better understanding of the management of the study. In fact, the cost of "old" ulcers is much higher than
venous leg ulcers in France, the different therapeutic the cost actually evaluated in this study. Fifty percent of the
approaches used, and their respective costs. Each physician mean cost of a venous ulcer is made up of procedures and
was asked to i clude two cases of leg ulcer, one "old" - care, and clearly indicates the need for topical treatment. The
existing for more than 6 weeks, the other "new" - progressing "drugs" heading accounts for 30% of the cost, and also
for less than 2 weeks. The case report forms had to be filled includes all types of dressing and support; it would be
out at each visit, either until healing occurred or for a worthwhile obtaining further details concerning this
maximum period of 6 months. The patient's clinical status, expenditure. Admission to hospital was regarded as
treatments, admission to hospital, etc were noted at each visit. infrequent and represented 15% of the cost; it would be
The effect of the treatments was assessed on the basis of the interesting to know the reasons for hospitalization and the
principal criterion, ie, healing and time to healing, and duration of the patient's stay; structures for outpatient
secondary criteria (percentage of patients showing management ought certainly to reduce the cost of
improvement, stabilization, or aggravation). A total of f
hospitalization. Regardless of the limitations o this study of
652 physicians participated, including 85.7% general costs, it is an undeniable fact that "old" ulcers cost too much.
practitioners, 10.1% angiology specialists, and 3.4% Everything possible should be done to institute rapid, effective
dermatologists - all physicians in private practice. management of venous ulcers. Recovery rates were
A total of 1098 patients were included, of whom 74% were significantly higher in the group of patients with "new" ulcers.
women, with a mean age of 72 years (9.5 % were in active Only 76% of patients were prescribed support hose at the
employment). 47.3% of the ulcers were "old" and 52.7% were inclusion visit, even though a venous ulcer was involved. This
"new." Concomitant diseases consisted of varicose veins means that one patient in four is not wearing support
(95.6%), osteoarthritis (57.1%), and hypertension (56.9%). In stockings. This constitutes an omission in management that
79.3% of the cases, the ulcer was the reason for the needs to be emphasized by the study if the organization of
consultation. The mean total cost/patient was 5827 French treatment is to be improved. This therapeutic failing, and the
francs; procedures and treatment accounted for almost 50%, low rate of mechanical cleansing, prevent any interpretation of
drugs for 30%, and hospitalization for 15%. A "new" ulcer cost the other therapeutic data (types of dressing). The
4669 francs, while an "old" ulcer cost 7078 francs. i
observational study could also have ncluded physicians in
The recovery rate was 67% for "old" ulcers and 86% for hospitals so as to get a complete, overall view of the
"new" ulcers (time to recovery was 4 weeks for the latter). management of venous ulcers in France.
The cost of a cured ulcer was about 10% less than that
Such observational studies of medical practice would make it
of ulcers in general. Support hose was prescribed right
from the start in 76% of cases, and cleansing in 58% . possible to compare recommendations that are made with
recommendations that are actually put into practice. Venous
By way of comment, it should be pointed out that the work ulcers are a source of handicap, cost, and need for long-term
referred to consisted of an observational study of medical treatment. The study has been of value in highlighting these
practice in dealing with venous ulcers. No conclusion can be parameters and providing encouragement to make even greater
drawn concerning the therapeutic management of the ulcers. improvements in the therapeutic management of venous ulcers.