OBJECTIVES: Assessment of the costs-of-illness of venous leg ulcers treated in German wound centers. METHODS: A nationwide cross-sectional study was performed in 31 specialized wound centers, including office- and clinic-based dermatologists, surgeons, GPs and internists. Patients with confirmed diagnosis of venous leg ulcer(s) were consecutively recruited, interviewed and asked to fill standardized questionnaires. Major outcomes parameters were the direct, indirect and intangible costs related to the leg ulcers from the societal perspective. The patient case report forms included questions on former treatment, health related quality of life, patient-relevant treatment benefit (PBI) and quality of care. The physician questionnaire focused on clinical data, co-morbidity, co-medication, wound status, resource consumption and all relevant types of costs related to the treatment of venous leg ulcers. RESULTS: In total, n= 218 patients (mean age: 69.8 ± 12.0 years, median= 71) were enrolled, including 62.1% women and 37.9% men. The median duration of ulceration was 7.0 years. The average total costs per patient summed up to €9569 per year, including €8658 of direct costs and €911 of indirect costs. The major proportions of direct costs were statutory health insurance costs (€7631) and out-of-pocket expenses (€1027). The most cost-driving factor was inpatient treatment (€3568), followed by non-drug treatment expenses (€740) and nursing fees in home care (€212). Health-related quality of life was considerably impaired in almost all of the patients, indicating high intangible costs of illness. CONCLUSIONS: Venous leg ulcers in Germany are associated with relevant direct, indirect and intangible costs suggesting early and qualified disease management. are associated with relevant direct, indirect and intangible costs suggesting early and qualified disease management.