Estimating & comparing the performance, clinical effectiveness, and cost-effectiveness of current diagnostic options for patients that present to primary care with suspected venous ulcers

Leg ulcers contribute to a huge socio-economic impact on the NHS annually, with over an excess of 100,000 active leg ulcers in the UK at any one time (Cunliffe 2021). Currently there is a wide variation in practice of leg ulcer management leading to a discrepancy in treatment that patients are receiving. Data collated from the Health Improvement Network database has shown that more than 90% ulcers remained unhealed at 6 months (Guest et al. 2012) . This, alongside other supporting reviews, leads to questions of these alarmingly low healing rates (White et al. 2013). Evidence suggests that this cohort of patients are being managed sub optimally in primary care and a more standardised approach needs to be taken to improve overall ulcer healing rates and ulcer prevent recurrence. Dressings alone will not heal these ulcers and prevent recurrence, the underlying cause of these ulcers must be determined and this cause treated (Cunliffe 2021). To further support this, early endovenous ablation of superficial vein reflux has been shown to result in faster healing of venous leg ulcers and a longer period of ulcer free time, compared to those that received delayed endovenous ablation (Gohel et al. 2019).
Primary care has limited resources for performing diagnostic investigations for suspected venous leg ulcers and limited appropriately trained staff to manage these patients. Additionally, the pathway for onward referral to a specialist ulcer service are variable and vary by geographical location (NHS England 2018).

The pathway of current practice from the patient first presenting to receiving this treatment, including vascular diagnostics, has not been investigated in detail, and is therefore not optimised. Assessing the cost effectiveness of implementing more advanced diagnostics in primary care and comparting this to running ulcer clinics in secondary care has also not been carried out.

The pathway of current practice from the patient first presenting to receiving this treatment, including vascular diagnostics, has not been investigated in detail, and is therefore not optimised. There is a lack of evidence and written documentation regarding diagnostics in the available guidelines. This means that there is a lack of standardised care for this cohort of patients across the UK.

It is hypothesised that by understanding how primary care currently refer onto specialist centres and establishing a consensus on what diagnostic tests should be performed on this cohort of patients, a conclusion on the most cost and clinical effective method of delivering diagnostics and care to this cohort of patients can be established. It is hypothesised that this will involve generating clearer guidelines and standardised pathways based on up-to-date literature for when VLU patients initially present into primary care, including when they should be referred onto specialist vascular centres, what specific diagnostic tests should be performed upon initial presentation and an outline of treatment options. The most cost-effective method may also suggest the initiation of specialist leg ulcer clinics involving a multidisciplinary team.

Outputs

None yet – but will work to write manuscripts soon.