Socio-economic impact of chronic venous insufficiency. An underestimated public health problem.

BACKGROUND: Disease of the venous system is an underestimated public health problem affecting all Western industrialised countries. The prevalence of venous disease of the lower limb in the adult population is estimated at 40-50% for men and 50-55% for women, whereas visible varicose veins and chronic venous insufficiency are, respectively, present in 10-15% and 2-7% of the male population and 20-25% and 3-7% of the female population. In France the costs of venous disease represented 2.6% of the total health care budget in 1995, thus confirming other data from European studies and an early health survey in the USA. To evaluate the socio-economic impact of chronic venous insufficiency by measuring the health care cost. METHODS: Detailed information on diagnostic and therapeutic procedures for venous disease was obtained from the billing data of the compulsory health insurance system in Belgium. Total ambulatory and intramural treatment costs are calculated for varicose veins of the lower limb and for haemorrhoids during the 1988-1995 period. RESULTS: Medical care costs for chronic venous disease amount to 10 billion BEF, which is 2-2.5% of the 1995 total health care budget. Annual spending on venotropic drugs with 11.5 mean daily doses per 1,000 inhabitants amounted to one billion BEF in 1995 for ambulatory treatment only. CONCLUSIONS: In view of the major medical, social and economical consequences of venous pathology, research and prevention efforts are required in this area as part of a well-targeted and effective health policy.

Social insurance cost of standard discectomy and percutaneous nucleotomy. A retrospective study of 87 social insurance claim files of male blue collar workers.

A retrospective review of social insurance claim files of male blue collar workers was conducted to compare the social insurance costs of percutaneous lumbar nucleotomy with standard lumbar discectomy ; 29 percutaneous nucleotomy procedures were matched with 58 standard discectomies all carried out between January 1992 and December 1994. It was concluded that a standard discectomy procedure results in significantly higher costs during hospitalisation with respect to surgery, anaesthesia and hospital stay. A percutaneous nucleotomy leads to a significantly higher outpatient expenditure especially in radiology and medical devices. The relative proportion of outpatient practitioner's visits and hospital stay costs was significantly higher for the standard discectomy whereas medical devices had a relatively higher share in outpatient expenditure for the percutaneous nucleotomy. In this population of 87 compensation claimants, the average social insurance costs did not significantly differ between the percutaneous nucleotomy and the standard discectomy.

[Cost analysis of inguinal hernia surgery in ambulatory and inpatient management]. / Kostenanalyse der Leistenhernienchirurgie bei ambulanter und stationärer Versorgung.

In Belgium 27,426 hernia repairs were performed in 1994 but only 1,451 (5.29%) were done on ambulatory basis, whereas in the U.S. over 50% of the yearly 600,000 hernia repairs are one day surgery procedures with interstate variation ranging from 6% to 89%. The mean treatment cost of inguinal hernia repair (doctors fees + hotel cost) was 53,704 BEF for inpatients vs. 30,510 BEF (general anesthesia) and 27,501 BEF (local anesthesia) for outpatients. Rates of complication and recurrence were not significantly different. This difference in total costs for hospital admission are determined by the mean length of stay and by the individual forfeitairy day price according to size of the hospital. Also the use of routine diagnostic procedures (clinical chemistry and medical imaging) - not necessarily essential for treatment - is higher at hospitalization. Even with 50% of all hernia repairs carried out in the one day clinic, total cost savings for treatment will hardly exceed 20% if the mean length of stay of the remaining inpatients will not decrease simultaneously. Supplementary and dramatic cost reductions however are possible by an earlier resumption of professional activities. The mean advised sick leave period of 4 weeks (+/- 2) still depends on irrelevant parameters as tradition, patients' preferences, job characteristics and type of insurance. Total costs for work incapacity add up to 2.5 billion BEF (vs. 1.4 billion BEF for total treatment costs) and can be cut by 50.18% via a mean 2 weeks earlier return to work. Since open primary hernia repair under local anesthesia can be easily carried out on outpatients resuming unrestricted daily activities in less than 1 week, the laparoscopic procedure with general anesthesia, higher treatment cost (endoscopic material) and still debated advantages in convalescence time and long-term outcome is not the gold standard for uncomplicated inguinal hernia.