Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study.
BACKGROUND
Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described.


OBJECTIVE
The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs.


METHODS
Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set.


RESULTS
The estimated total average cost for a seven week treatment period (including appliances and accessories) was 263€ for those with PSCs (n = 1742) compared to 215€ for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p<0.00001 and from 'rarely/never' to 'sometimes' p = 0.0115.


CONCLUSIONS
PSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications.
Stoma Care Clinic, Bispebjerg University Hospital, Copenhagen, Denmark.
Søren
S
Meisner
Paul-Antoine
PA
Lehur
Brendan
B
Moran
Lina
L
Martins
Gregor Borut Ernst
GB
Jemec
D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000191:economics* / Q000628:therapy; D012871:Skin Diseases / Q000191:economics* / Q000209:etiology / Q000628:therapy; D054047:Surgical Stomas / Q000009:adverse effects