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A venous leg ulcer is a chronic wound which, if not treated appropriately, can endure for years. The wound can be painful and will often restrict physical and social mobility. Patients are typically treated by a community nurse at home or in a specialist clinic. There are more than 200,000 new venous leg ulcers annually in the UK.

It is well accepted that treatment with multi-layer high compression improves healing compared with no compression or low compression bandaging.² The superior performance of high compression compared with traditional dressings has two positive impacts on efficiency:

The use of high compression in appropriate patients leads to shorter healing times and lower treatment costs overall.
Because of the greater durability of high compression bandages compared with traditional products, wear time is longer and costs are reduced by the lower frequency of dressing changes.
These benefits have been demonstrated in a number of studies. One study³ compared clinical outcomes for patients with a venous leg ulcer treated with multi-layer high compression and the usual care provided by community nurses in a typical health authority in England. Usual care involved many different treatments, including traditional non-compression dressings. In this study, after 24 weeks of treatment, 40% more patients were healed with high compression than with usual care. In the high compression group, nurses visited on average just over once a week to change dressings. With the cheaper products in the usual care regime, nurses visited more than twice a week.

An improvement in the efficacy of treatment is expected to lead to a reduction in the overall costs of patient care. Table 1 shows a comparison between the cost of treating a patient with a venous leg ulcer with PROFORE^◊ compared with the usual care provided by community nurses in a typical health district in England. Costs are based on the clinical results reported in a study by Morrell³. In this study PROFORE^◊ healed almost 40% more patients at 24 weeks and required fewer dressing changes (PROFORE^◊ was changed on average once per week compared with twice per week for the usual care regime). The expected saving in cost amounts to a reduction of 45% on the cost of usual care.

In a usual care regime, 80% of the total cost of care is the cost of nurse time. Thus, despite the fact that PROFORE^◊ costs more than the typical dressings used in a non-compression regime, overall treatment cost is lower with PROFORE^◊ because of the lower frequency of dressing changes and because of its greater efficacy.

	Treatment with PROFORE◊	%	Treatment with Usual Care	%
Cost per dressing change
- Nurse time	£16.00	60.1	£16.00	80.9
- Dressings	£8.90	33.4	£2.05	10.4
- Other costs	£1.73	6.5	£1.73	8.7
	£26.63	100	£19.78	100
Dressing changes per week	1.1		2.2
% healed in 52 weeks		71		60
Average weeks to heal	15.9 weeks		19.2 weeks
Cost per patient per year	£772.00		£1,406.00

1. Granick MS, Posnett J, Jacoby M, Noruthum S, Ganchi P, Datiashvili. Efficacy and cost-effectiveness of the high-powered parallel waterjet wound debridement. Wound Repair & Regeneration, 2006;14:394-397.
2. Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update software.
3. Morrell CJ, Walters SJ, Dixon S, Collins K, Brereton LML, Peters J, Brooker CGD. Cost effectiveness of community leg ulcer clinics; randomised controlled trial. British Medical Journal, 1998. 316:1487-91