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The economic impact of infection requiring hospitalization on venous leg ulcers
Raffi Melikian1, Thomas F O'Donnell2, Mark Iafrati3
1Tufts University School of Medicine, Boston, Mass; Department of Surgery, University of Southern California, Los Angeles, Calif.
Insights
Infection in patients with venous leg ulcers (VLU) significantly increases medical resource utilization and healthcare costs. Preventing infection is crucial for managing VLU and reducing patient expenses.
Area of Science:
- Vascular Surgery
- Wound Care
- Health Economics
Background:
- Venous leg ulcers (VLUs) are chronic wounds that can lead to significant morbidity.
- Infection is a common complication of VLUs, impacting patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To determine the impact of infection (INF) on medical resource utilization (MRU) and cost of care in patients with VLUs.
Main Methods:
- Retrospective case-control study of 78 patients with C6 VLUs over a 12-month follow-up period.
- Infection (INF) group defined by inpatient admission specifically for VLU-related infection.
- MRU assessed via clinic visits, Visiting Nurse Association (VNA) visits, and inpatient admissions; costs analyzed from hospital and physician billing data.
Main Results:
- Patients with VLU infections (INF) had significantly higher MRU, including more outpatient wound center visits (16.89 vs 9.46) and VNA visits (3.89 vs 1.94).
- Total healthcare costs for the INF group ($27,408) were threefold higher than for the non-infected (NON-INF) group ($11,088).
- INF patients showed a higher proportion of congestive heart failure (44% vs 13%).
Conclusions:
- Infection in VLU patients substantially increases medical resource utilization and overall cost of care.
- The findings highlight the need for improved treatment modalities to prevent infections and identify associated risk factors in VLU patients.
Objective:
To determine the impact of infection (INF) on medical resource utilization (MRU) and cost of care in patients with venous leg ulcers (VLU).
Methods:
We performed a retrospective case-control study of 78 patients followed for a minimum of 12 months with C6 VLUs treated by vascular surgeons, at our wound center. To eliminate minor episodes of INF or incorrectly diagnosed episodes, only patients who had an inpatient admission specifically for INF comprised the INF group, whereas all other admissions were excluded for this group. MRU was defined as the number of clinic visits, Visiting Nurse Association (VNA) visits, and inpatient admissions. The actual cost for treatment was determined using financial data provided by both the hospital and physician organization billing units. The total cost over the 1-year follow-up period comprised individual cost centers: inpatient and outpatient facility fees, physician fees, and visiting nurse services. Mean MRU and cost data were compared using the two-sample t-test between INF and NON-INF.
Results:
Of the 78 patients with C6 VLU, 9 (11.5%) had at least one inpatient admission for INF related to their VLU in the 1-year treatment period, with an additional five recurrent admissions for a total of 14 admissions, whereas 69 NON-INF had three NON-INF-related admissions. There was no difference between INF and NON-INF for usual risk factors, but INF had a greater proportion of congestive heart failure (44%; 13%, P < .02). Regarding MRU, both the number of outpatient wound center visits (INF 16.89 ± 6.41; NON-INF 9.46 ± 7.7, P = .008) and VNA blocks (INF 3.89 ± 2.93; NON-INF 1.94 ± 2.24, P < .02) were greater for INF. Total costs for INF ($27,408 ± $10,859) were threefold higher than those for NON-INF ($11,088 ± $9343, P < .0001) and subsequent VNA costs were doubled for INF ($9956 ± $4657) vs NON-INF ($4657 ± $5486, P = .01).
Conclusions:
INFs in patients with VLU led to an overall increase in MRU and cost of care, with the INF cohort requiring more inpatient admissions, outpatient visits, and VNA services than NON-INF. Given the major impact INF has on cost and MRU, better treatment modalities that prevent INF as well as identifying risk factors for INF in patients with VLU are needed.
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