COST-EFFECTIVENESS OF COMMUNITY LEG ULCER CLINICS - RANDOMIZED CONTROLLED TRIAL

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usu al care provided by district nurses. Design: Randomised controlled tri al with 1 year of follow up. Setting: Eight community based research c linics in four trusts in Trent Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) grou p. Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nurs ing service (control group). Main outcome measures: Time to complete u lcer healing, patient health status, and recurrence of ulcers. Satisfa ction with care, use of services, and personal costs were also monitor ed. 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 gr oup were healed compared with 24% in the control. The crude initial he aling rate of ulcers in intervention compared with control patients wa s 1.45 (95% confidence interval 1.04 to 2.03), No significant differen ces were found between the groups in health status. Mean total NHS cos ts were pound 878.06 per year for the clinic group and pound 859.34 fo r the control (P = 0.89). Conclusions: Community based leg ulcer clini cs with trained nurses using four layer bandaging is more effective th an traditional home based treatment. This benefit is achieved at a sma ll additional cost and could be delivered at reduced cost if certain s ervice configurations were used.