Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system

Belczak, Sergio Quilici; Gornati, Vitor Cervantes; Aun, Ricardo; Sincos, Igor Rafael; Fragoso, Hélio

doi:10.1590/S1679-45082011GS1984

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Health Economics and Management • EINSEinstein (São Paulo) 9 (3) • Jul-Sep 2011 • https://doi.org/10.1590/S1679-45082011GS1984 copy

Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To perform an analysis of the costs of treatment of varicose ulcers by radical surgery of varices and the use of Unna boot.

Methods:

Fifteen outpatients were selected to receive treatment of varicose ulcers with radical surgery and Unna boot. The total cost of treatment was calculated (hospitalization, surgery, dressings, and outpatient's follow-up visits) and compared to the cost of clinical follow-up with daily simple dressing changes.

Results:

The proposed treatment was on average 55.71% more economical than the management with daily dressings (approximately US$452.32 versus US$1,021.39).

Conclusion:

Radical varicose vein surgery associated with the use of the Unna boot proved meaningly less expensive for the public health system than clinical follow-up with daily dressings.

Keywords:
Varicose ulcer/surgery; Varicose ulcer/economics; Public health

Material	Quantity (unit)	Unit Price (R$)	Price adjusted for the quantity (R$)
Sterile gauzes 7.5 × 7.5 cm	20	0.23 (10)	0.46
Rayon 7.5 × 20 cm	1 (unit)	1.85 (1 unit)	1.85
Elastic bandage 15 × 180 cm	1 (unit)	0.39 (1 unit)	0.39
Procedure glove	1 (pair)	0.3 (1 pair)	0.30
Sterile glove	1 (pair)	1.32 (1 pair)	1.32
Saline solution	250 (mL)	0.7 (1 unit)	0.70
Paper sheet 0.8 × 100 m	2 (m)	14 (100 m)	0.28
Dersani lotion 20 mL	10 (mL)	3.8 (1 tube)	1.90
Self-adhesive tape 16 × 50 m	60 (cm)	2.25 (1 roll)	0.03
Nursing fees	5 (minutes)	0.176 (1 minute)	0.88
Total price(R$)			8.11

Material	Quantity (unit)	Unit price (R$)	Price adjusted for quantity (R$)
Unna boot	1 (unit)	25.00 (1 unit)	25.00
Elastic bandage 15 × 180 cm	1 (unit)	0.39 (1 unit)	0.39
Procedure glove	1 (pair)	0.3 (1 pair)	0.30
Sterile glove	1 (pair)	1.32 (1 pair)	1.32
Saline solution	250 (mL)	0.7 (1 unit)	0.70
Paper sheet 0.8 × 100m	2 (m)	14 (100 m)	0.28
Self-adhesive tape 16 × 50 m	60 (cm)	2.25 (1 roll)	0.03
Nursing fees	15 (minutes)	0.176 (1 minute)	2.64
Total price (R$)			30.66

Patient	Sex	Age (at surgery)	Time of ulcer on the leg	Estimated time of ulcer in activity according to the patient (in years)	Percentage of time with open ulcer (as estimated by the patient) (%)	Size (longest diameter) of the ulcer(s) at admission for surgery (cm)
1	M	54	11	6	54.54	6.9
2	M	54	10	6	60.00	4.1
3	M	40	3.5	2	57.14	6.5
4	F	29	11	7	63.64	4.2
5	M	46	17	8	47.06	12.1
6	M	46	15	7	46.67	4.4
7	M	52	1.5	0.8	53.33	4.1
8	M	64	8	4	50.00	4.6
9	M	48	2.5	1	40.00	1.8
10	F	45	9	5	55.56	4.7
11	M	59	13	9	69.23	4.5
12	M	59	14	6	42.86	3.1
13	F	64	12	5	41.67	4.8
14	M	43	15	9	60.00	8.3
15	F	46	0.5	0.4	80.00	3.9
Mean		49.93	9.53	5.08	55.22	5.2

Patient	Sex	Number of Unna boots used	Time for closure of ulcer(s) in weeks after surgery	Correct use of boot (scheduled weekly changes)	Elastic stockings after ulcer remission	Follow-up time (months)	Occurrence of relapse after combined treatment
1	M	3	4	Yes	Yes	9	No
2	M	3	4	Yes	Yes	9	No
3	M	6	7	Yes	Yes	9	No
4	F	7	9	fertiel	Partial	10	No
5	M	5	6	Yes	Yes	10	No
6	M	5	6	Yes	Yes	10	No
7	M	6	7	No	Partial	8	No
8	M	6	7	Yes	Yes	10	No
9	M	2	3	fertiel	Yes	5	No
10	F	3	4	Yes	Yes	11	No
II	M	3	4	Yes	Yes	6	No
12	M	3	4	Yes	Yes	4	No
13	F	3	4	Yes	Partial	5	No
14	M	4	5	Yes	Yes	5	No
15	F	3	4	Yes	Yes	4	No
Mean		4.13	5.07			7.666

Dressing/Procedure	Price adjusted by day (R$)	Price adjusted by week (R$)	Price adjusted by year (R$)
Daily dressing	8.11	56.75	2,959.05
Unna's boot	4.38	30.66	1,598.54
Difference (R$)	3.73	26.09	1,360.51
Difference (%)	-45.98

Clinical visit	Procedure	Quantity (mean)	Unit price (R$)	Price adjusted for quantity (R$)
Outpatient – SUS		8.07	10.00 (1 unit)	80.70
Visit to the ward (clinical evolution) – SUS		2	40.38 (1 unit)	80.76
	Unna's boot (entire dressing) – SUS	4.13	30.66 (1 unit)	126.70
	Surgical treatment of varices (unilateral) – SUS	1	483.37 (1 unit)	483.37
	High compression elastic stockings – Not routinely furnished by SUS	1	55.00 (1 pair)	55.00
				826.53

Dressing/procedure	Price adjusted per day (R$)	Price adjusted per week (R$)	Price adjusted per year (R$)
Daily dressing	8.11	56.75	2,959.05
Unna's boot	4.38	30.66	1,598.53
Surgery + boot + return visits + stockings	2.27	15.89	826.53
Surgery + boot + return visits	2.11	14.80	771.53

Dressing/procedure	Price adjusted by day (R$)	Price adjusted by week (R$)	Price adjusted by year (R$)
Daily dressings	4.48	31.34	1,634.08
Surgery + boot + returning visits + stockings	2.27	15.89	826.53
Difference (R$)	2.21	15.44	807.54
Difference (%)	-49.27

Patient	Time of ulcer on leg	Estimated time of ulcer in activity as per the patient (in years)	Total estimated cost of dressings considering 55.223% of the time with an active ulcer (R$)	Annual cost according to the individual percentage of time of active ulcer (R$)	Absolute cost of therapy combined with surgery and Unna's boot (R$)
1	11.0	6.0	17,974.87	1,614.02	671.10
2	10.0	6.0	16,340.79	1,775.43	671.10
3	3.5	2.0	5,719.27	1,690.89	793.07
4	11.0	7.0	17,974.87	1,883.03	843.73
5	17.0	8.0	27,779.34	1,392.47	752.41
6	15.0	7.0	24,511.18	1,380.89	752.41
7	1.5	0.8	2,451.12	1,578.15	793.07
8	8.0	4.0	13,072.63	1,479.53	793.07
9	2.5	1.0	4,085.20	1,183.62	630.44
10	9.0	5.0	14,706.71	1,643.92	671.10
11	13.0	9.0	21,243.03	2,048.58	671.10
12	14.0	6.0	22,877.10	1,268.17	671.10
13	12.0	5.0	19,608.95	1,232.94	671.10
14	15.0	9.0	24,511.18	1,775.43	711.76
15	0.5	0.4	817.04	2,367.24	671.10
Mean	9.53	5.080	15,578.22	1,620.95	717.84

Patient	Percentage of time with open ulcer (as estimated by the patient) (%)	Total absolute cost if ulcer is considered permanently open (R$)	Cost considering 55.223% of the time with active ulcer (R$)	Total cost according to individual percentage of active ulcer time (R$)
1	54.54	32,549.60	17,974.87	17,754.18
2	60.00	29,590.55	16,340.79	17,754.33
3	57.14	10,356.69	5,719.28	5,918.11
4	63.64	32,549.60	17,974.87	20,713.38
5	47.06	50,303.93	27,779.34	23,672.03
6	46.67	44,385.82	24,511.18	20,713.38
7	53.33	4,438.58	2,451.12	2,367.23
8	50.00	23,672.44	13,072.63	11,836.22
9	40.00	7,397.64	4,085.20	2,959.05
10	55.56	26,631.49	14,706.71	14,795.27
11	69.23	38,467.71	21,243.03	26,631.49
12	42.86	41,426.77	22,877.10	17,754.33
13	41.67	35.508.66	19,608.95	14,795.27
14	60.00	44,385.82	24,511.18	26,631.49
15	80.00	1,479.53	817.04	1,183.62
Mean	55.22	28,209.66	15,578.22	15,031.96

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[1] Corresponding author: Sergio Quilici Belczak – Avenida Albert Einstein, 627 – Morumbi – CEP 05651-901 – São Paulo (SP), Brazil – Tel.: 11 2151-1233 – E-mail: belczak@gmail.com