Korn P, Patel ST, Heller JA, Deitch JS, Krishnasastry KV, Bush HL, Kent KC, et al.
Journal of vascular surgery. Date of publication 2002 May 1;volume 35(5):950-7.
1. J Vasc Surg. 2002 May;35(5):950-7.
Why insurers should reimburse for compression stockings in patients with chronic
venous stasis.
Korn P(1), Patel ST, Heller JA, Deitch JS, Krishnasastry KV, Bush HL, Kent KC.
Author information:
(1)Division of Vascular Surgery, New York Presbyterian Hospital, Cornell Campus,
525 East 68th Street, New York, NY 10021, USA. kckent@mail.med.cornell.edu
BACKGROUND: Chronic venous stasis ulcers produce substantial morbidity rates and
result in a significant expense to society. Fortunately, compression stockings
(CS) have been found to reduce the rate of recurrence in patients with previous
ulceration. Surprisingly, Medicare and other insurers do not reimburse the
expense associated with CS or with patient education (Ed), which is essential to
ensure compliance.
METHODS: A Markov decision analysis model was used for analysis of the
cost-effectiveness of a strategy of reimbursement for CS and Ed (prophylaxis)
versus one that does not supply these resources in a 55-year-old patient with
prior venous stasis ulceration. The mean time to ulcer recurrence (53 months with
CS+Ed; 18.7 months without prophylaxis), the mean time for ulcer healing (4.6
months), the probabilities of hospitalization (12%) and amputation (0.4%) after
the development of an ulcer, and quality-adjustment factors (0.80 during ulcer
treatment) were derived from the literature. The cost of CS ($300/year) and Ed
($93 for initial evaluation; $58/year; $40/recurrence) and the medical cost of
ulcer treatment (average cost, $1621/recurrence) were calculated from our
hospital cost accounting system.
RESULTS: A strategy of CS and Ed was cost saving, with 0.37 quality-adjusted life
years and $5904 saved, compared with a strategy that does not provide these
resources. The inclusion of loss of revenue related to absence from work in the
analysis increased cost savings to $17,080 during the patient's lifetime. With
sensitivity analysis, CS and Ed remained cost-effective (lifetime cost per
quality-adjusted life year saved, <$60,000) if amputations and the cost of ulcer
treatment were eliminated or if the cost of prophylaxis was increased to 600% of
the base-case. The mean time to recurrence in patients with CS and Ed needed to
be reduced from 53 months to 21.1 months before this strategy was no longer
cost-effective.
CONCLUSION: Prophylactic CS and Ed in patients with prior venous stasis
ulceration are cost saving, even with the most conservative of assumptions.
Insurers should routinely reimburse for these interventions.
PMID: 12021694 [Indexed for MEDLINE]
