Cost effectiveness of community leg ulcer clinics: randomised controlled trial
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 f...
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| Published in: | BMJ Vol. 316; no. 7143; pp. 1487 - 1491 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
British Medical Journal Publishing Group
16-05-1998
British Medical Association BMJ Publishing Group LTD BMJ Publishing Group British Medical Journal |
| Edition: | International edition |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | 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 |
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| Bibliography: | ark:/67375/NVC-C5XN3110-7 PMID:9582132 local:bmj;316/7143/1487 Correspondence to: Dr Morrell istex:A48B9224723DA7BF2539B7178B176BE88EFFE3B8 href:bmj-316-1487.pdf ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-News-3 Contributors: CJM was involved in the design of the research protocol, coordinated the setting up of the study, and participated in the data collection, management, analysis, and interpretation of the data and the writing of the paper. SJW contributed to the statistical analysis and interpretation of the data and drafting and revising the paper. SD contributed to the economic analysis and interpretation of the data and drafting and revising the paper. KC and LB participated in preparing databases, data collection, management and analysis, and editing of the paper. JP was involved in setting up the study, preparing databases, data collection, management and analysis, and editing of the paper. CB initiated the formulation of the study hypothesis, secured the funding for the trial, and was involved in the conception and design of the study protocol and the editing of the paper. Correspondence to: Dr Morrell j.morrell1@sheffield.ac.uk |
| ISSN: | 0959-8138 0959-8146 1468-5833 1756-1833 |
| DOI: | 10.1136/bmj.316.7143.1487 |