title: Expenditure of chronic venous leg ulcer management in German primary care: results from a population-based study.
abstract: The aim of the study was to determine the demand on health service utilisation and to estimate the therapeutical costs caused by patients with chronic leg ulcer (CLU) in German primary care. A population-based case-control study was conducted using electronic medical records of 116 059 patients extracted from the CONTENT primary care database of Heidelberg, Germany, between April 2007 and March 2010. The drug and non drug prescription rates among patients with CLU were analysed by means of a unified German identification key and compared with those of patients with chronic venous insufficiency (CVI) without CLU. In the 3-year-contact group, CLU patients had significantly more patient-doctor encounters (55·9 versus 40·3; p < 0·0001), more referrals to home-care services (6·12 versus 3·08; p < 0·0001), and more admissions to hospitals (0·9 versus 0·4; p < 0·0001) than CVI patients, but no difference in referrals to specialists. The annual treatment costs for drugs and non drugs in CLU patients were substantially higher than in CVI patients (1645·75 € versus 1188·17 €; p < 0·0001). Wound dressings were identified as the most cost-enlarging factor. Summarising, CLU patients in primary care settings place a higher demand on health service utilisation and need nearly one-third higher therapeutical costs compared to venous patients without ulceration.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital, Voßstrasse 2, Heidelberg, Germany. uwe.mueller-buehl@med.uni-heidelberg.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Müller-Bühl
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Leutgeb
authors.forename: Jessica
authors.initials: J
authors.lastname: Bungartz
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Gunter
authors.initials: G
authors.lastname: Laux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages / Q000191:economics; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014647:Varicose Ulcer / Q000191:economics* / Q000628:therapy