Department of General Surgery, Khoo Teck Puat Hospital, Yishun, Singapore.
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
J Vasc Surg Venous Lymphat Disord. 2023 Sep;11(5):954-963. doi: 10.1016/j.jvsv.2023.05.009. Epub 2023 May 19.
Venous leg ulcers (VLUs) are both chronic and recurrent. The treatment of such ulcers often require multiple outpatient visits and dressing changes. Several reports on the costs of treating such VLUs have been reported in the west. We prospectively evaluated the clinical and economic burden of VLUs in a population of Asian patients in the tropics.
Patients from a prospective two-center study conducted at two tertiary hospitals in Singapore, as a part of the Wound Care Innovation in the Tropics program, between August 2018 and September 2021 were recruited. The patients were followed up for 12 weeks (visit 1 to visit 12), until index ulcer healing, death, or lost to follow-up (whichever came first). These patients were then followed up 12 weeks later to determine the longer term outcome of the wound (healed, recurrence, remained unhealed). The itemized costs derived from the medical service were retrieved from the relevant departments of the study sites. The patients' health-related quality of life was assessed at baseline and the last visit of the 12-week follow-up period (or until index ulcer healing), using the official Singapore version of the EuroQol five-dimension-5L questionnaire, which also includes a visual analog scale (EQ-VAS).
A total of 116 patients were enrolled; 63% were men, and the mean patient age was 64.7 years. Of the 116 patients, 85 (73%) had a healed ulcer at 24 weeks (mean duration to ulcer healing, 49 days), and 11 (12.9%) had experienced ulcer recurrence within the study period. Within the 6-month follow-up period, the mean direct healthcare cost per patient was USD$1998. The patients with healed ulcers had significantly lower costs per patient compared with those with unhealed ulcers (USD$1713 vs USD$2780). Regarding health-related quality of life, 71% of the patients had a lower quality of life at baseline, which had improved at 12 weeks of follow-up, with only 58% of the patients reported to have a lower quality of life. Also, the patients with healed ulcers scored higher for both utilities (societal preference weights) and EQ-VAS at follow-up (P < .001). In contrast, patients with unhealed ulcers only scored higher EQ-VAS at follow-up (P = .003).
The findings from this exploratory study provide information on the clinical, quality of life, and economic burden of VLUs in an Asian population and suggest the importance of healing VLUs to reduce the effects on patients. The present study provides data as a basis for economic evaluation as a consideration for the treatment of VLUs.
静脉性腿部溃疡（venous leg ulcers，VLUs）是慢性且易复发的。此类溃疡的治疗通常需要多次门诊就诊和更换敷料。西方已有多项关于治疗此类 VLUs 成本的报告。我们前瞻性评估了热带地区亚洲患者人群中 VLUs 的临床和经济负担。
2018 年 8 月至 2021 年 9 月，在新加坡的两家三级医院进行的一项前瞻性双中心研究的患者作为热带地区伤口护理创新计划的一部分被纳入研究。患者在 12 周（就诊 1 至就诊 12）的随访期间接受治疗，直到指数溃疡愈合、死亡或失访（以先发生者为准）。这些患者在 12 周后接受了进一步的随访，以确定伤口的长期结局（愈合、复发、未愈合）。从研究地点的相关科室获取医疗服务产生的分项费用。在 12 周随访期的基线和最后一次就诊时（或直至指数溃疡愈合），使用官方新加坡版 EuroQol 五维-5L 问卷评估患者的健康相关生活质量，该问卷还包括视觉模拟量表（EQ-VAS）。
共有 116 名患者入组；63%为男性，平均患者年龄为 64.7 岁。在 116 名患者中，85 名（73%）在 24 周时溃疡愈合（溃疡愈合的平均时间为 49 天），11 名（12.9%）在研究期间溃疡复发。在 6 个月的随访期间，每位患者的直接医疗保健费用平均为 1998 美元。与未愈合的溃疡患者相比，愈合的溃疡患者每位患者的成本显著更低（1713 美元比 2780 美元）。关于健康相关生活质量，71%的患者基线时生活质量较低，12 周随访时有所改善，只有 58%的患者报告生活质量较低。此外，愈合溃疡的患者在随访时的效用（社会偏好权重）和 EQ-VAS 评分更高（P<0.001）。相比之下，未愈合溃疡的患者仅在随访时 EQ-VAS 评分更高（P=0.003）。
这项探索性研究的结果提供了亚洲人群中 VLUs 的临床、生活质量和经济负担的信息，并表明愈合 VLUs 以减少对患者的影响的重要性。本研究提供了数据作为经济评估的依据，以考虑 VLUs 的治疗。
