Cost effectiveness of community leg ulcer clinics: randomised controlled trial

BMJ 1998;316:1487-1491 ( 16 May )

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Cost effectiveness of community leg ulcer clinics: randomised controlled trial

C Jane Morrell, research fellow, ^a Stephen J Walters, statistician, ^a Simon Dixon, lecturer, ^a Karen A Collins, research associate, ^a Louise M L Brereton, research associate, ^b Jean Peters, research fellow, ^a Charles G D Brooker, professor of nursing. ^c

^a School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, ^b School of Nursing and Midwifery, Samuel Fox House, Northern General Hospital, Sheffield S5 7NA, ^c School of Nursing, University of Manchester, Coupland III Building, Manchester M13 9PL

Correspondence to: Dr Morrell j.morrell1{at}sheffield.ac.uk

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compressionbandaging versus usual care provided by district nurses.
Design: Randomised controlled trial with 1 year of follow up.
Setting: Eight community based research clinics in four trusts in Trent.
Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group.
Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at homeby the district nursing service (control group).
Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfactionwith 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 thewhole 12 month follow up (log rank P=0.03). At 12 weeks, 34% ofpatients in the clinic group were healed compared with 24% inthe control. The crude initial healing rate of ulcers in interventioncompared with control patients was 1.45 (95% confidence interval1.04 to 2.03). No significant differences were found between thegroups in health status. Mean total NHS costs were £878.06 peryear for the clinic group and £859.34 for the control (P=0.89).
Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective thantraditional home based treatment. This benefit is achieved ata small additional cost and could be delivered at reduced costif certain service configurations were used.

Key messages

Leg ulcer clinics based in the community using four layer compression bandaging can be more clinically effective than usual care provided by the district nursing service
Community based leg ulcer clinics could be provided more cost effectively than usual home based care for venous leg ulcers
Recurrence of venous leg ulcers is an important variable that should be measured in future trials of venous leg ulcer care
It is difficult to measure improvements in health related quality of life among people with venous leg ulcers

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