A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers

J O U R N A L O F WO U N D C A R E VO L 1 5 , N O 8 , S E P T E M B E R 2 0 0 6 3 4 8 C ommunity leg ulcer clinics have emerged as a new approach to leg ulcer management. Studies have found that they improved healing rates1-3 when compared with individual nursing care. Such clinics provide easier access to wound care specialist nurses, increased social interaction and improved information exchange between healthcare team members.4 The Lindsay Leg Club model has extended this concept (Box 1).4 Economic studies of leg ulcer management strategies have mainly concentrated on management products rather than modes of delivery or systems of care.5 However, four studies have investigated the cost-effectiveness of different models of delivery,6-9 three of which compared new leg ulcer clinic interventions with traditional home nursing.6,7,9 Clinic costs were either lower7,9 or similar,6 while healing rates were 10–68% better than traditional home nursing.6,7,9 However, Bosanquet et al.’s6 use of historical controls for the ‘usual care group’ may have exaggerated the difference in effects, while in Ellison et al.’s study7 it is unclear whether healing improvements in the clinic sample were attributable to the clinic model or the different bandaging techniques used: the clinics used specialised high compression techniques whereas ‘traditional care’ involved alternative products. Kerstein et al.8 studied home nursing and physician care services using identical protocols, and found increased costs with home nursing, although both yielded similar levels of effectiveness.