[Comparison of ambulatory and inpatient treatment of XXXX of the leg: subjective and economic aspects].

@entity1 @entity450 @entity1151 @entity1150 @entity148 @entity158 @entity291
The frequency of clinical recurrence and @entity1151 in @entity1 with @entity1150 is reduced to the same extent by hospital treatment (with unfractionated heparin) as by treatment at home (with low-molecular-weight heparin). Very few data on subjective parameters of effectiveness have been published. We performed a prospective randomized trial comparing outpatient with in-hospital treatment in 28 @entity1 . Six clinical and quality-of-life related parameters of effectiveness were assessed quantitatively: clinical course (with a score system), @entity158 of @entity450 of the @entity291 muscles (with Lowenberg's test), subjective perception of @entity158 and general well-being (with visual analogue scales), satisfaction with the care provided, and absence from work. Subjective effectiveness was compared with the costs of each form of treatment. Outpatient treatment was significantly more effective than in-hospital treatment with regard to the objective parameters. It was, however, associated with less well-being and more @entity158 than in-hospital treatment. The discrepancy is explained by eventually insufficient adjuvant treatment measures (which consisted of external leg compression by stockings and forced walking) and by @entity148 brought on by the information that potentially lethal @entity1151 could occur despite anticoagulant therapy. Outpatient treatment was less costly. On the average and per @entity1 it was CHF 3944 less expensive than treatment in hospital. An estimation reveals that the Swiss health care system would save about CHF 25 million per year if the 85% of @entity1 with @entity1150 suitable for home care were given this form of treatment. We conclude that outpatient management is subjectively cost-effective but should be optimised to eliminate certain drawbacks associated with it.
