Clinical outcomes and cost-effectiveness of three different compression systems in newly-diagnosed venous leg ulcers in the UK
Clinical outcomes and cost-effectiveness of three different compression systems in newly-diagnosed venous leg ulcers in the UK
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DOI：
10.12968/jowc.2017.26.5.244
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发表时间：
2017-05-01
影响因子：
1.9
通讯作者：
Vowden, P.
中科院分区：
文献类型：
--
作者：
Guest, J. F.;Fuller, G. W.;Vowden, P.
目的：评估使用双层粘性压迫绷带的临床结局和成本效益（TLCCB;科班2）与双层加压系统相比（TLCS; KTwo）和四层压缩系统（FLCS; Profore）在英国的临床实践中治疗新诊断的下肢静脉溃疡（VLU）。方法：这是一项回顾性队列分析，对从健康改善网络（THIN）数据库中随机抽取的新诊断VLU患者的病例记录进行分析（英国全科医生注册患者临床实践的全国代表性数据库），接受TLCCB治疗（n = 200），TLCS（n = 200）或FLCS（n = 200）。临床结果和成本效益的替代压缩系统估计超过六个月后开始treatment.Results：患者的平均年龄为72岁，58%是女性。从伤口开始到开始压迫的时间平均为2个月，开始压迫时伤口大小平均为45 cm（2）。三组之间的愈合分布存在显著差异; TLCCB组有76%的伤口在6个月内愈合，而TLCS和FLCS组分别为70%和64%（p = 0.006）。TLCCB组的愈合时间显著短于其他两组（p = 0.003）。TLCCB组患者在6个月内的健康相关生活质量（每例患者0.413质量调整生命年）优于TLCS和FLCS组（每例患者分别为0.404和0.396 Qs）。TLCCB、TLCS和FLCS组的平均6个月NHS管理成本分别为3045英镑、3842英镑和4480英镑。现实世界的证据表明，与其他两种压缩系统相比，使用TLCCB治疗新诊断的VLU在临床实践中提供了NHS资助资源的更具成本效益的使用，因为它提高了治愈率，更好的健康相关生活质量和降低NHS管理成本。
Objective: 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.Method: 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.Results: 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(2). 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 pound, 3842 pound and 4480 pound per patient in the TLCCB, TLCS and FLCS groups, respectively.Conclusion: 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.