title: Clinical outcomes and cost-effectiveness of three alternative compression systems used in the management of venous leg ulcers.
abstract: OBJECTIVE
  To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS).
  
  
  METHODS
  This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates.
  
  
  RESULTS
  Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was £2,413, £2,707 and £2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively.
  
  
  CONCLUSIONS
  Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing.
  
  
  BACKGROUND
  This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.
authors.affiliation: Director of Catalyst, Visiting Professor of Health Economics;, Research Nurse;, Researcher Assistant;, Northwood, Middlesex, UK.|Director of Catalyst, Visiting Professor of Health Economics;, Faculty of Life Sciences and Medicine, King's College, London, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Guest
authors.affiliation: Director of Catalyst, Visiting Professor of Health Economics;, Research Nurse;, Researcher Assistant;, Northwood, Middlesex, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gerrish
authors.affiliation: Director of Catalyst, Visiting Professor of Health Economics;, Research Nurse;, Researcher Assistant;, Northwood, Middlesex, UK.
authors.forename: N
authors.initials: N
authors.lastname: Ayoub
authors.affiliation: RN, Nurse Consultant;, Consultant Vascular Surgeon, Professor of Wound Healing Research 1 Catalyst Health Economics Consultants, Bradford Teaching Hospitals NHS Foundation Trust and University of Bradford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Vowden
authors.affiliation: RN, Nurse Consultant;, Consultant Vascular Surgeon, Professor of Wound Healing Research 1 Catalyst Health Economics Consultants, Bradford Teaching Hospitals NHS Foundation Trust and University of Bradford, UK.
authors.forename: P
authors.initials: P
authors.lastname: Vowden
mesh_terms: D000368:Aged; D058128:Compression Bandages / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology*
keywords: Coban 2; KTwo; Profore; UK; compression; cost-effectiveness; economic evaluation; venous leg ulcer