Cost effectiveness of community leg ulcer clinics: randomised controlled trial.
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.
Morrell
C J
CJ
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA. j.morrell1@sheffield.ac.uk
Walters
S J
SJ
Dixon
S
S
Collins
K A
KA
Brereton
L M
LM
Peters
J
J
Brooker
C G
CG
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