Olin J W, Beusterien K M, Childs M B, Seavey C, McHugh L, Griffiths R I
Department of Vascular Medicine, Cleveland Clinic Foundation, OH 44195, USA.
Vasc Med. 1999;4(1):1-7. doi: 10.1177/1358836X9900400101.
Venous stasis ulcers (VSU) account for approximately 80-90% of lower extremity ulcerations. Given their prevalence and chronic nature, VSU are thought to impose a significant economic burden on Medicare (the USA's largest health insurance program) and other third party payers. However, comprehensive studies on the costs of VSU treatment are lacking. The objective of this study therefore was to examine comprehensively the direct medical costs of treating patients with a VSU in routine clinical practice. A cohort of 78 patients who presented with a VSU to the Cleveland Clinic Foundation (CCF), a large primary and tertiary referral center, was studied retrospectively. 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 seven (range: 2 to 57). A total of 14 (18%) patients underwent 18 hospitalizations for VSU care. The average total medical cost per patient was $9685 (median: $3036). Home health care, hospitalizations and home dressing changes accounted for 48%, 25% and 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 costs were not examined. Time absent from work, forced early retirement, loss of functional independence and unquantifiable suffering may be additional factors that contribute to the overall burden of VSU.
静脉淤滞性溃疡（VSU）约占下肢溃疡的80 - 90%。鉴于其患病率和慢性病程，VSU被认为给医疗保险（美国最大的医疗保险项目）和其他第三方支付方带来了巨大的经济负担。然而，目前缺乏关于VSU治疗成本的全面研究。因此，本研究的目的是全面考察在常规临床实践中治疗VSU患者的直接医疗成本。对78例在大型初级和三级转诊中心克利夫兰诊所基金会（CCF）就诊的VSU患者进行了回顾性研究。对VSU出现后一年内或直至溃疡愈合（以先发生者为准）期间发生的所有与VSU治疗相关的住院和门诊费用进行了量化。在研究期间，共有71例（91%）患者愈合。平均随访时间为119天（中位数：84天）。每位患者的平均就诊次数为7次（范围：2至57次）。共有14例（18%）患者因VSU治疗住院18次。每位患者的平均总医疗费用为9685美元（中位数：3036美元）。家庭医疗护理、住院治疗和家庭换药分别占总费用的48%、25%和21%。总费用与积极治疗的持续时间、溃疡大小以及至少存在一种合并症有关（p<0.05）。VSU的管理成本高昂，尤其是愈合时间延长时。由于未考察间接成本，目前的研究结果可能低估了VSU的成本。误工时间、被迫提前退休、功能独立性丧失以及难以量化的痛苦可能是导致VSU总体负担加重的其他因素。
