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. 2012;7(5):e37813.
doi: 10.1371/journal.pone.0037813. Epub 2012 May 24.

Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study

Søren Meisner  1 , Paul-Antoine Lehur, Brendan Moran, Lina Martins, Gregor Borut Ernst Jemec
Affiliations

Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study

Søren Meisner et al. PLoS One. 2012.

Abstract

Background: Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described.

Aim: The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs.

Methods: Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set.

Results: The estimated total average cost for a seven week treatment period (including appliances and accessories) was 263€ for those with PSCs (n = 1742) compared to 215€ for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p<0.00001 and from 'rarely/never' to 'sometimes' p = 0.0115.

Conclusion: PSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: Meisner declares consultancy for Coloplast. Lehur, Jemec, Martins, and Moran previously received honaria from Coloplast. Jemec and Martins previously received a research grant from Coloplast. All authors have declared in individual letters, that can be mailed upon request, that the funding does not influence or alter their adherence to all PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Model design for cost estimation of PSC.
Figure 2
Figure 2. Sensitivity analysis of ±20% change in PSC cost presented in Tornado diagram.
Figure 3
Figure 3. Cost of PSC according to level of severity (DS).
PSC: Peristomal Skin Complication. DS: Dialogue Study.
Figure 4
Figure 4. Cost of PSC according to diagnostic categories (DS).
*Other: Was assigned an imputed cost equal to the weighted average cost for a patient with known cause of PSC with the same level of severity. PSC: Peristomal Skin Complication. DS: Dialogue Study.
Figure 5
Figure 5. Cost of PSC according to leakage level (DS).
PSC: Peristomal Skin Complication. DS: Dialogue Study.
See this image and copyright information in PMC

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