Prospective study on the clinical and economic burden of venous leg ulcers in the tropics.

Autor: Chan DYS; Department of General Surgery, Khoo Teck Puat Hospital, Yishun, Singapore. Electronic address: chan.dexter.ys@ktph.com.sg., Surendra NK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore., Ng YZ; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore., Lee SH; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore., Yong E; Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore., Hong Q; Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore., Goh CC; Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore., Lai TP; Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore., Tan AHM; Wound and Stoma Care, Nursing Specialty, Tan Tock Seng Hospital, Singapore, Singapore., Law CCC; Department of Podiatry, Khoo Teck Puat Hospital, Yishun, Singapore., Liang S; Department of Surgery, Woodlands Health, Singapore, Singapore., Car J; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom., Lo ZJ; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Surgery, Woodlands Health, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Journal of vascular surgery. Venous and lymphatic disorders [J Vasc Surg Venous Lymphat Disord] 2023 Sep; Vol. 11 (5), pp. 954-963. Date of Electronic Publication: 2023 May 19.
DOI: 10.1016/j.jvsv.2023.05.009
Abstrakt: Objective: 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.
Methods: 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).
Results: 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).
Conclusions: 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.
(Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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