title: Management of leg and pressure ulcer in hospitalized patients: direct costs are lower than expected.
abstract: BACKGROUND
  In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients.
  
  
  METHODS
  The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany.
  
  
  METHODS
  Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented.
  
  
  METHODS
  Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined.
  
  
  RESULTS
  An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average.
  
  
  CONCLUSIONS
  When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this saving might be lower than expected. Our results, however, do not serve as basis for making any conclusions on cost-benefit analysis for both, the affected individual, as well as for the society.
authors.affiliation: Clinical Institute for Hospital Hygiene, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Oswald
authors.forename: Rainer
authors.initials: R
authors.lastname: Leisten
authors.forename: Peter
authors.initials: P
authors.lastname: Hinz
authors.forename: Georg
authors.initials: G
authors.lastname: Daeschlein
authors.forename: Axel
authors.initials: A
authors.lastname: Kramer