BMJ 1998;317:1079 ( 17 October )

Letters

Cost effectiveness of community leg ulcer clinics

    Study compared dressing techniques in selected group of patients
    Study's comparison was outdated
    Trial design means useful conclusions are limited
    Effectiveness and cost effectiveness of compression bandages should be shown
    Author's reply

Study compared dressing techniques in selected group of patients

The first 150 words of the full text of this article appear below.

EDITOR---Morrell et al conducted a randomised controlled trial assessing the cost and clinical effectiveness of community leg ulcer clinics.1 We are concerned that the trial design precludes a meaningful assessment of the value of these clinics.

Sixty five patients were excluded because they were unable to travel to the clinic, and they did not undergo any formal assessment; these patients still require a home visiting nursing service. It is unreasonable to conclude that a clinic based service is more cost effective when 16.5% of those requiring treatment were excluded from the study owing to immobility. It would have been more valuable to transport half of these patients to the clinic and include those costings in the analysis. Treatment effectiveness would be better assessed by comparing treatment with the Charing Cross bandaging technique2 in the clinic with the same treatment in the home. The patients treated at home received . . . [Full text of this article]
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