Intended for healthcare professionals


Cost effectiveness of community leg ulcer clinics: randomised controlled trial

BMJ 1998; 316 doi: (Published 16 May 1998) Cite this as: BMJ 1998;316:1487
  1. C Jane Morrell, research fellow (j.morrell1{at},
  2. Stephen J Walters, statisticiana,
  3. Simon Dixon, lecturera,
  4. Karen A Collins, research associatea,
  5. Louise M L Brereton, research associateb,
  6. Jean Peters, research fellowa,
  7. Charles G D Brooker, professor of nursingc
  1. a School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA
  2. b School of Nursing and Midwifery, Samuel Fox House, Northern General Hospital, Sheffield S5 7NA
  3. c School of Nursing, University of Manchester, Coupland III Building, Manchester M13 9PL
  1. Correspondence to: Dr Morrell
  • Accepted 2 February 1998


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


    • Accepted 2 February 1998
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