Simka Marian, Majewski Eugeniusz
Out-Patient Department of Angiology, Pszczyna ul. Wodzislawska 78-43-200 Pszczyna, Poland.
Am J Clin Dermatol. 2003;4(8):573-81. doi: 10.2165/00128071-200304080-00007.
Chronic venous insufficiency (CVI) occurs in a relatively large proportion of the population and is associated with significant morbidity, high cost of healthcare, loss of productivity and reduced quality of life. Lower extremity ulcers related to CVI have been estimated to affect 0.2-1% of the population in developed countries. The prevalence of venous ulcers in the US is estimated at 500,000-600,000, and increases with age. Estimates of the annual incidence of leg ulcer in the UK and Switzerland are 3.5 and 0.2 per 1000 individuals, respectively. Treatment of venous ulcers can be expensive, leading to a large economic burden on health services in many countries. The annual cost of CVI is estimated to be more than 1 billion US dollars in the US and between pound 400-600 million in the UK. Current treatments for CVI include surgery, sclerotherapy, compressive therapy (conventional therapy) and adjuvant pharmacotherapy. Various pharmacological agents have been used as adjuvant therapy but in many cases there is no definitive evidence of their efficacy. Effective treatment programs for venous leg ulcers could substantially reduce the economic impact of CVI on health services. In controlled studies, micronized purified flavonoid fraction (MPFF) adjuvant therapy has been shown to increase significantly the number of healed venous leg ulcers and to reduce significantly the healing time of ulcers compared with conventional therapy alone, potentially leading to an improvement in patients' quality of life. The treatment of venous leg ulcers with MPFF was also found to reduce overall treatment costs compared with conventional therapy alone. In a retrospective cost-effectiveness analysis based on direct medical costs only, MPFF therapy improved the cost-effectiveness ratio by 45% compared with conventional therapy. If intangible costs, such as loss of quality of life were included, the difference in cost-effectiveness ratios is likely to be even greater in favor of MPFF. Sensitivity analyzes showed that even with a 20% increase in drug price the cost-effectiveness ratio for MPFF therapy was substantially better than that for conventional therapy (1061.8 US dollars vs 1871.9 US dollars per ulcer healed). Hence, the addition of MPFF adjuvant therapy to the treatment of venous leg ulcers would be effective and potentially cost saving.
慢性静脉功能不全（CVI）在相当大比例的人群中出现，与显著的发病率、高昂的医疗保健成本、生产力损失及生活质量下降相关。据估计，在发达国家，与CVI相关的下肢溃疡影响着0.2% - 1%的人口。美国静脉溃疡的患病率估计为50万 - 60万例，且随年龄增长而增加。英国和瑞士腿部溃疡的年发病率估计分别为每1000人中有3.5例和0.2例。静脉溃疡的治疗费用可能很高，给许多国家的卫生服务带来巨大经济负担。在美国，CVI的年成本估计超过10亿美元，在英国则为4亿 - 6亿英镑。CVI的现有治疗方法包括手术、硬化疗法、压迫疗法（传统疗法）和辅助药物治疗。各种药物制剂已被用作辅助治疗，但在许多情况下，并无确凿证据证明其疗效。有效的下肢静脉溃疡治疗方案可大幅降低CVI对卫生服务的经济影响。在对照研究中，与单纯传统疗法相比，微粉化纯化黄酮类成分（MPFF）辅助治疗已显示可显著增加愈合的下肢静脉溃疡数量，并显著缩短溃疡愈合时间，这可能会改善患者的生活质量。与单纯传统疗法相比，用MPFF治疗下肢静脉溃疡还能降低总体治疗成本。在仅基于直接医疗成本的回顾性成本效益分析中，与传统疗法相比，MPFF疗法使成本效益比提高了45%。如果将生活质量损失等无形成本包括在内，成本效益比的差异可能更有利于MPFF。敏感性分析表明，即使药物价格上涨20%，MPFF疗法的成本效益比仍显著优于传统疗法（每治愈一例溃疡，MPFF疗法为1061.8美元，传统疗法为1871.9美元）。因此，在下肢静脉溃疡治疗中添加MPFF辅助治疗将是有效的，且可能节省成本。
