Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers

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Abstract
Background: The aim of this study was to compare the cost‐effectiveness of four‐layer compression bandaging for venous leg ulcers with that of other available treatments. Methods: In this pragmatic trial, 200 patients with a venous leg ulcer were randomized either to four‐layer bandaging (intervention group; n = 100) or to continue their usual system of care (control group; n = 100). The follow‐up for each patient was 12 weeks. Analysis was by intention to treat; the main outcome measures were time to healing and cost to the health board per leg healed. Results: Baseline characteristics were well matched in the two groups. The Kaplan–Meier estimate of the healing rate at 3 months was 54 per cent with four‐layer bandaging and 34 per cent in the control group. Throughout the 3 months, four‐layer bandaging healed leg ulcers significantly earlier (P = 0·006). There was a significant reduction in the median cost per leg healed with four‐layer bandaging (€210 versus €234; P = 0·040). Conclusion: Four‐layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.