Goka Edward A, Poku Edith, Thokala Praveen, Sutton Anthea
School of Health and Related Research, Faculty of Medicine Dentistry and Health, The University of Sheffield, Sheffield, England.
Wounds. 2020 Jan;32(1):11-21.
This study evaluates the clinical and cost effectiveness of a 2-layer compression system (2LBA; 3M Coban Two-Layer Compression System; 3M, St Paul, MN) compared with other 2-layer (2LB) and 4-layer (4LB) compression systems in patients with noninfected venous leg ulcers (VLUs).
The MEDLINE, EMBASE, CINAHL, Cochrane Library, National Health Service (NHS) Economic Evaluation, and EconLit databases were searched from inception up to January 2017. The MEDLINE search was updated on March 31, 2017. Study selection, quality assessment, and data synthesis were undertaken in accordance with recommended standards. Findings were presented narratively.
In total, 5 studies (N = 1509 patients) of mixed methodological quality were included. At 6 months, 2LBA achieved better ulcer healing in comparison with 2LBB (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.10-2.24; P = .03) and 4LBA (OR, 1.93, 95% CI, 1.26-2.97; P = .05) in patients with newly diagnosed ulcers only. For a combined population with newly diagnosed and existing VLUs, healing outcomes were OR, 2.87; 95% CI, 1.06-7.77; P = .04, and OR, 16.51; 95% CI, 2.08-131.37; P = .008, for 2LBs and 4LBs, respectively. Results on slippage were inconclusive. Adverse events were infrequent and did not differ significantly between interventions. Lower 6-month NHS costs for the combined population (£2413 vs. £2707 or £2648) and for newly diagnosed patients (£3045 vs. £3842 or £4480) were observed comparing 2LBA with 2LBB or 4LBA. Also, 2LBA was associated with better health-related quality of life (HRQoL) at 6 months.
Based on these findings, 2LBA may result in lower treatment costs and better ulcer healing and HRQoL compared with other multicomponent therapies, especially in patients with newly diagnosed VLUs. However, further high-quality research is needed, especially for outcomes such as slippage and bandage wear time.
本研究评估了一种双层加压系统（2LBA；3M Coban双层加压系统；3M公司，明尼苏达州圣保罗）与其他双层（2LB）和四层（4LB）加压系统相比，在非感染性下肢静脉溃疡（VLU）患者中的临床效果和成本效益。
检索了MEDLINE、EMBASE、CINAHL、Cochrane图书馆、英国国家医疗服务体系（NHS）经济评估数据库以及EconLit数据库，检索时间从建库至2017年1月。2017年3月31日对MEDLINE搜索进行了更新。按照推荐标准进行研究选择、质量评估和数据综合。研究结果以叙述形式呈现。
总共纳入了5项方法学质量参差不齐的研究（N = 1509例患者）。在6个月时，仅对于新诊断溃疡的患者，与2LBB相比，2LBA实现了更好的溃疡愈合（优势比[OR]，1.57；95%置信区间[CI]，1.10 - 2.24；P = 0.03），与4LBA相比也是如此（OR，1.93，95% CI，1.26 - 2.97；P = 0.05）。对于新诊断和已存在VLU的联合人群，2LBs和4LBs的愈合结果分别为OR，2.87；95% CI，1.06 - 7.77；P = 0.04，以及OR，16.51；95% CI，2.08 - 131.37；P = 0.008。关于滑脱的结果尚无定论。不良事件很少见，且不同干预措施之间无显著差异。与2LBB或4LBA相比，联合人群（2413英镑对2707英镑或2648英镑）和新诊断患者（3045英镑对3842英镑或4480英镑）在6个月时的NHS成本更低。此外，2LBA在6个月时与更好的健康相关生活质量（HRQoL）相关。
基于这些发现，与其他多组分疗法相比，2LBA可能导致更低的治疗成本、更好的溃疡愈合和HRQoL，尤其是在新诊断的VLU患者中。然而，需要进一步的高质量研究，特别是对于滑脱和绷带佩戴时间等结果。
