Background: As our general population ages, the prevalence of venous leg ulcers is increasing. The disease consumes substantial healthcare resources and the financial burden of VLU care is increasing. Multiple implementations aimed at cost reduction have not yielded the expected results. Because we know that healthcare organisation can be an important target of cost reduction, we have created a new healthcare chain for diagnosing and treating venous leg ulcers. Objective: To define and compare costs of treatment and evaluate costreduction in a one-stop clinic compared to standard care for venous leg ulcers (VLU). Methods: We followed prospectively all new patients with a single VLU. The research group consisted of patients of the one-stop-clinic and received homecare by dedicated wound care nurses. The control group received regular care. We investigated personnel costs and facility costs related to ulcer care using the S-ABC method. Results: Research group consisted of 12 and control group of 8. The groups were similar in baseline characteristics. The mean total cost via the one-stopclinic was €522.85 vs. €841.17 receiving standard care (p=0.093). After bootstrapping, we found an absolute difference of €125.39 (€618.97 vs. €744.36) (p<0.001); a cost-reduction of 16%. Conclusion: An absolute cost-reduction of almost €300,-per patient and after bootstrapping a cost-reduction of 16% was found, indicating using onestop-clinics and high educated wound care nurses could lead to cost-effective wound care.
Venous leg ulcers (VLU) are a major burden for health care systems around the world, especially with an ageing population and an increasing prevalence [1,2]. It is estimated that 1% of Western health care budgets are compromised by venous ulcer care [3,4]. VLU’s have a tendency to lead to chronic wounds [5] and therapy could take months [5,6]. Ulcers are invalidating and painful and could greatly reduce patient’s quality of life limiting daily activities, such as work. Ulcer healing has been shown to restore quality of life [7]. VLE are often caused by underlying venous insufficiency and accounts for 70% of all leg ulcers [1-8,9]. Treatment consists of compression therapy and local wound treatment such as various wound dressings, debridement, excision of the ulcer or skin grafting (9-12) and aim for faster wound healing. Early treating venous insufficiency as underlying cause by superficial venous surgery can reduce the chance of a recurrent ulcer and result in faster ulcer healing [13,14]. The nature of the wound, ulcer size and duration determines the healing chances and therefore the type of treatment. Diagnosing and treatment by experienced and trained healthcare professionals is required [15]. Establishing a quick and correct diagnosis and initiating proper treatment will result in a shorter time of wound healing, restoring of quality of life and simultaneously a cost reduction is expected.

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