[Medico-economic study of the management of leg ulcers of venous origin. Initial results].
OBJECTIVE
There is little data on the different techniques used in France to treat venous leg ulcers. Due to the lack of a well-accepted standard, it is most likely that therapeutic attitudes vary greatly. An assessment of the respective cost/benefit ratios would be most useful, but requires prior knowledge of the techniques used. We therefore conducted a survey of the main management schemes applied in France.


METHODS
A cross-sectional survey involved 800 investigators (85% general practitioners. 15% specialists: angiologists and dermatologists) throughout France. Each investigator was invited to include 2 patients with venous ulcerations of the leg. One patient was to have a long-standing ulceration (at least 6 weeks duration) and the other a new ulceration (less than 2 weeks duration). Patients were followed to cure or to study end-point six months after diagnosis. The clinical observations at inclusion are presented here for 247 patients with venous ulcerations.


RESULTS
The patient population showed a clear predominance and advanced age (mean 72 years). In half of the cases, the diagnosis was made at a home visit and in 20% of the cases at an office visit for a reason other than leg ulceration. History taking revealed a high frequency of varicose veins, osteoarthritis of the lower limbs and high blood pressure as well as a high rate of recurrence (60% for long-standing ulcerations). Treatments prescribed at the first visit were divided into 10 groups. The most frequently used methods were: cleansing, contention and general therapy (antibiotics, anticoagulants, antiaggregates, analgesics). General practitioners focused primary treatment on general therapies and local care while specialists used contention more often (more than 90%) and different skin treatments. These different treatment combinations were then grouped into 7 main types of therapeutic attitudes, differentiating between general practitioners and specialists. There were however three common elements found in the treatments applied by more than 50% of the physicians: cleansing (99%), combined with contention (64%) or a general therapy (56%).


CONCLUSIONS
The main observation was that contention is used at a relatively high percentage (77%). This survey must be continued with a larger number of inclusion visits and an analysis of follow-up visits in order to identify possible changes in therapeutic attitudes and the associated costs as a function of treatment duration and rate of cure within the 6 month period.
Levy
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LEGOS, Université de Paris-Dauphine.
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004470:Economics, Medical; D005260:Female; D005602:France; D006801:Humans; D007871:Leg Ulcer / Q000191:economics / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D014680:Veins
Etude médico-économique de la prise en charge des ulcères de jambe d'origine veineuse. Premiers résultats.