Health service costs of treating venous leg ulcers in the UK: evidence from a cross-sectional survey based in the north west of England

ObjectivesTo estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK.DesignCost-of-illness study.SettingA cross-sectional survey of nine National Health Service community locales over 2-week periods in 2015/2016.MethodsWe examined the resource use and prevalence of venous leg ulcer treatment in the community. Examination of variation in these obtained costs was performed by ordinary least squares regression. We used additional resource use information from a randomised control trial and extrapolated costs to the UK for an annual period.ResultsThe average 2-week per person cost of treating patients where a venous leg ulceration was the primary (most severe) wound was estimated at £166.39 (95% CI £157.78 to £175.00) with community staff time making up over half of this amount. Costs were higher where antimicrobial dressings were used and where wound care was delivered in the home. Among those with any recorded venous leg ulcer (primary and non-primary), we derived a point prevalence of 3.2 per 10 000 population and estimated that the annual prevalence could be no greater than 82.4 per 10 000 population. We estimated that the national cost of treating a venous leg ulcer was £102 million with a per person annual cost at £4787.70.ConclusionOur point prevalence figures are in line with the literature. However, our annual prevalence estimations and costs are far lower than those reported in recent literature which suggests that the costs of treating venous leg ulcers are lower than previously thought. Movement towards routinely collected and useable community care activity would help provide a transparent and deeper understanding of the scale and cost of wound care in the UK.

Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study

Aim To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. Methods A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. Design Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. Results A sample of 143 participants was recruited (51% male, M age = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks ( SE 1.63, 95% CI 33.7–40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications ( p = .035), presence of haemosiderosis ( p = .006), decreased mobility (longer sitting times) ( p = .007) and lower social support scale scores ( p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance ( p = .06). Conclusion Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.

Hypericum perforatum and Azadirachta indica (Neem) oil in the management of chronic leg ulcers: An uncontrolled retrospective observational case review

Chronic nonhealing leg ulcers are debilitating with high morbidity in a vulnerable patient population and pose a frequent clinical and socioeconomic problem. Numerous local treatment options exist, but clinical trials are rare and wound management still represents a big challenge. Recently a wound dressing based on the natural remedies Hypericum perforatum and Neem oil has been proposed for chronic wound management, but trials on nonhealing leg ulcers are missing. Uncontrolled retrospective observational case review on all patients under our supervision with chronic leg ulcers who underwent treatment with a plant-derived wound dressing based on Hypericum perforatum and Azadirachta indica (Neem) oil. It could be retrieved in a total 16 cases (11 female) with a median age of 71 years. All ulcers (7 ulcers on the leg and 9 ulcers on the feed) showed a complete healing after a median healing time of 82 days (Mean 85, range 14-180 days). No side effects occurred, medication was painless or even reduced pain. Wound dressings based on Hypericum perforatum and Neem oil are well tolerated and could be a potential additional simple treatment option in the management of non-healing leg ulcers. Prospective controlled trials are needed to confirm these observations.

Impact of educational nursing intervention on compression therapy adherence and recurrence of venous leg ulcers: a quasi-experimental study

Following the healing of venous leg ulcers, the primary problems for nursing and patients are adhering to compression therapy and preventing ulcer recurrence. As a result, it is important that patients comprehend their situation. The purpose of this study is to see how an educational nursing intervention affected compression therapy adherence and recurrence of venous leg ulcers in patients with chronic venous leg ulcers. A quasi-experimental design is used, including an intervention, a control group, and before and post-assessments. This study is conducted in one of Egypt's largest teaching hospitals associated with Menoufia University. A 20-month study included 80 adult patients with healed venous leg ulcers. Each participant is randomized to either a control (got regular leg ulcer information) or study (received educational interventions) group. The following tools are used in the study: bio-sociodemographic variables, knowledge evaluation, compression therapy adherence scale, and recurrence follow-up, after three, six, and twelve months of implementation. Furthermore, there is a statistically significant difference between the study groups during the pretest (r=0.885, 0.774, 0.477, p=0.002). The use of nurse education increased patients' understanding and adherence to compression treatment substantially. As a consequence, those with chronic venous leg ulcers may be able to avoid recurrent venous leg ulcers.