Related Experiment Video
Updated: Aug 5, 2026
08:05
Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Compression systems for venous leg ulcers: a network meta-analysis and cost-effectiveness analysis
Han Phung1, Catherine Arundel2, Jo Dumville3
1Centre for Health Economics, University of York, York, YO10 5DD, UK.
Eclinicalmedicine
|July 28, 2026
Summary
Four-layer bandage systems (4LB) and two-layer hosiery (2LH) are cost-effective for treating venous leg ulcers. While other compression systems show small differences in healing effectiveness, 4LB/2LH offer the best value from a UK NHS perspective.
Area of Science:
- Vascular Surgery
- Wound Healing
- Health Technology Assessment
Background:
- Compression therapy is crucial for venous leg ulcer (VLU) treatment.
- Four-layer bandage systems (4LB) and two-layer hosiery (2LH) are established effective treatments.
- The comparative effectiveness and cost-effectiveness of two-layer bandage systems (2LB), compression wraps (CW), and short-stretch bandages (SSB) remain uncertain.
Purpose of the Study:
- To compare the effectiveness of 4LB/2LH against 2LB, SSB, and CW in terms of time to VLU healing.
- To evaluate the cost-effectiveness of these compression systems from a UK National Health Service (NHS) perspective.
Main Methods:
- Updated systematic review and meta-analysis of randomized controlled trials (RCTs) on compression systems for VLU.
- Network meta-analysis (NMA) used to estimate relative treatment effects on time to ulcer healing (Hazard Ratio).
- Markov modeling employed for lifetime cost-effectiveness analysis, estimating total costs, Quality-Adjusted Life Years (QALYs), and Incremental Cost-Effectiveness Ratios (ICERs).
Main Results:
- No significant differences in time to ulcer healing were found between 4LB/2LH and SSB, 2LB, or CW across various bias assessments.
- Cost-effectiveness analysis indicated small cost and QALY differences; SSB and CW were dominated by 4LB/2LH.
- The ICER for 2LB versus 4LB/2LH was £159,614 per QALY gained, suggesting lower cost-effectiveness for 2LB.
Conclusions:
- Potential small differences in clinical effectiveness exist among compression systems, but estimates carry uncertainty.
- Four-layer bandage systems (4LB) and two-layer hosiery (2LH) emerge as the most cost-effective option in the UK.
- Further research may be needed to clarify precise effectiveness differences and guide optimal compression system selection.
Related Concept Videos
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:31Diabetic Foot Ulcer
Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory neuropathy reduces pain perception,...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...