OBJECTIVES: Estimation of cost-of-illness (COI) of leg ulcers in two German cross-sectional studies using different methodical approaches. METHODS: A direct and an indirect method for cost estimation were utilized. In a nationwide cross-sectional study in 33 specialized dermatological, surgical and general-medical wound centres, resource consumption and associated costs of venous leg ulcer(s) were collected directly from physicians and patients. In a second cross-sectional regional study, involving 147 institutions (hospitals, residencies, nursing services, dermatological offices, services for homeless and addictives) treating patients with ulcus cruris, resource consumption and associated costs were inferred from history, wound condition and actual/previous treatments based on standardized cost categories. Main economic parameters in both studies were direct, indirect and intangible costs (health related quality of life, HRQoL) from the societal perspective. RESULTS: The national study enrolled n=218 patients with a mean age of 69.8 years (regional study: n=502, 71 years). Wounds existed for 7 (regional 9) years on average. The mean total COI per year and patient was €9,569 (€10,624). While direct costs summed up to €8658 (€9851), indirect costs were much lower €911 (€772). Of direct costs, €7631 (€9122) were covered by the Statutory Health Insurances (SHI) and €1027 (€730) by the patients. For SHI, major cost factors were inpatient costs, non-drug treatments and physicians/nurses fees. Moreover, clinical predictors such as wound size, number and duration as well as wound etiology and characteristics of care (quality, support) were identified. All patients were severely impaired in their HRQoL, implying a high burden of disease and relevant intangible costs.   CONCLUSIONS: Chronic leg ulcers generate highly relevant COI. Despite different recruitment and cost estimation methods, both studies resulted in comparable direct, indirect and intangible costs; observed differences can be attributed to sample characteristics. The results point to early and qualified disease management in all related health services areas.