Cost effectiveness of community leg ulcer clinics: randomised controlled trial
BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7143.1487 (Published 16 May 1998) Cite this as: BMJ 1998;316:1487
- C Jane Morrell, research fellow (j.morrell1{at}sheffield.ac.uk)a,
- Stephen J Walters, statisticiana,
- Simon Dixon, lecturera,
- Karen A Collins, research associatea,
- Louise M L Brereton, research associateb,
- Jean Peters, research fellowa,
- Charles G D Brooker, professor of nursingc
- 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
- Accepted 2 February 1998
Abstract
Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging 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 home by the district nursing service (control group).
Main outcome measures: 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 per year 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 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.
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
Footnotes
- Accepted 2 February 1998