Stockings or bandages for leg-ulcer compression?

Four-layer bandaging is the standard treatment for venous leg ulcers but is bulky and can restrict mobility. Two-layer compression stockings have recently been marketed but their clinical and cost effectiveness were unknown.

To compare the clinical and cost effectiveness of four-layer bandaging with two-layer compression stockings.

In a pragmatic, open, randomised controlled trial 454 participants were randomly allocated two-layer compression stockings or four-layer bandages and followed for up to 12 months after healing.

The median time to ulcer healing was almost identical (stockings group: 99 days, bandaging group: 98 days). More patients allocated stockings changed treatment but ulcer recurrence rates were higher in the bandaging group. Stockings cost 302 sterling pounds less per participant per year and had more than 95% probability of being the most cost-effective treatment.

Two-layer compression stockings are a viable, cost-effective alternative to four-layer bandaging but may not be suitable for all patients.