Guest J F, Fuller G W, Vowden P
Director of Catalyst, Visiting Professor of Health Economics; Catalyst Health Economics Consultants, Northwood, Middlesex, UK; Faculty of Life Sciences and Medicine, King's College, London, UK.
Research Assistant; Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
J Wound Care. 2017 May 2;26(5):244-254. doi: 10.12968/jowc.2017.26.5.244.
To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; KTwo) and a four-layer compression system (FLCS; Profore) in treating newly-diagnosed venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the NHS.
This was a retrospective cohort analysis of the case records of patients with newly-diagnosed VLUs randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK) who were treated with either TLCCB (n=200), TLCS (n=200) or FLCS (n=200). The clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over six months after starting treatment.
Patients' mean age was 72 years and 58% were female. Time from wound onset to the start of compression was a mean of two months, and when starting compression the wound size was a mean of 45 cm. The distribution of healing was significantly different between the three groups; 76% of wounds in the TLCCB group healed by six months compared with 70% and 64% in the TLCS and FLCS groups, respectively (p=0.006). Time to healing was significantly less in the TLCCB group compared with the two other groups (p=0.003). Patients in the TLCCB group experienced better health-related quality of life over six months (0.413 quality-adjusted life years (QALYs) per patient), compared with the TLCS and FLCS groups (0.404 and 0.396 QALYs per patient, respectively). The mean six-month NHS management cost was £3045, £3842 and £4480 per patient in the TLCCB, TLCS and FLCS groups, respectively.
Real-world evidence demonstrates that treating newly-diagnosed VLUs with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice since it resulted in an increased healing rate, better health-related quality of life and a reduction in NHS management cost.
从英国国家医疗服务体系（NHS）的角度，评估在临床实践中使用双层粘性加压绷带（TLCCB；Coban 2）与双层加压系统（TLCS；KTwo）和四层加压系统（FLCS；Profore）治疗新诊断的下肢静脉溃疡（VLUs）的临床疗效和成本效益。
这是一项回顾性队列分析，从健康改善网络（THIN）数据库（英国全科医生注册患者中具有全国代表性的临床实践数据库）中随机提取新诊断为VLUs且接受TLCCB（n = 200）、TLCS（n = 200）或FLCS（n = 200）治疗的患者的病例记录。在开始治疗后的六个月内评估替代加压系统的临床疗效和成本效益。
患者的平均年龄为72岁，58%为女性。从伤口出现到开始加压的时间平均为两个月，开始加压时伤口大小平均为45平方厘米。三组之间的愈合分布有显著差异；TLCCB组76%的伤口在六个月内愈合，而TLCS组和FLCS组分别为70%和64%（p = 0.006）。与其他两组相比，TLCCB组的愈合时间显著更短（p = 0.003）。与TLCS组和FLCS组（分别为每位患者0.404和0.396个质量调整生命年（QALYs））相比，TLCCB组患者在六个月内的健康相关生活质量更好（每位患者0.413个QALYs）。TLCCB组、TLCS组和FLCS组患者的NHS平均六个月管理成本分别为3045英镑、3842英镑和4480英镑。
实际证据表明，与其他两种加压系统相比，在临床实践中使用TLCCB治疗新诊断的VLUs能更具成本效益地利用NHS资助的资源，因为它提高了愈合率，改善了健康相关生活质量，并降低了NHS管理成本。
