title: Cost effectiveness of community leg ulcer clinics: randomised controlled trial.
abstract: OBJECTIVE
  To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses.
  
  
  METHODS
  Randomised controlled trial with 1 year of follow up.
  
  
  METHODS
  Eight community based research clinics in four trusts in Trent.
  
  
  METHODS
  233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group.
  
  
  METHODS
  Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group).
  
  
  METHODS
  Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored.
  
  
  RESULTS
  The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2. 03). No significant differences were found between the groups in health status. Mean total NHS costs were 878.06 pounds per year for the clinic group and 859.34 pounds for the control (P=0.89).
  
  
  CONCLUSIONS
  Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA. j.morrell1@sheffield.ac.uk
authors.forename: C J
authors.initials: CJ
authors.lastname: Morrell
authors.forename: S J
authors.initials: SJ
authors.lastname: Walters
authors.forename: S
authors.initials: S
authors.lastname: Dixon
authors.forename: K A
authors.initials: KA
authors.lastname: Collins
authors.forename: L M
authors.initials: LM
authors.lastname: Brereton
authors.forename: J
authors.initials: J
authors.lastname: Peters
authors.forename: C G
authors.initials: CG
authors.lastname: Brooker
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D000554:Ambulatory Care Facilities / Q000191:economics; D001458:Bandages; D003153:Community Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000191:economics; D006801:Humans; D007871:Leg Ulcer / Q000191:economics / Q000628:therapy*; D008297:Male; D017060:Patient Satisfaction; D012008:Recurrence; D019035:Rural Health Services / Q000191:economics; D016896:Treatment Outcome; D019037:Urban Health Services / Q000191:economics