Clinical and Cost-Effectiveness of Compression Hosiery Versus Compression Bandages in Treatment of Venous Leg Ulcers (Venous Leg Ulcer Study IV, VenUS IV): A Randomised Controlled Trial

Study Questions:

What is the clinical effectiveness and cost-effectiveness of two-layer compression hosiery with four-layer compression bandages for the treatment of venous leg ulcers?


This was a multicenter open, randomized controlled trial, in which 457 patients with at least one venous leg ulcer were randomly allocated to two-layer compression hosiery that delivered 40 mm Hg pressure at the ankle (n = 230) or a four-layer bandage (n = 227). The primary endpoint was time to ulcer healing (measured by masked assessment of photographs and defined by complete epithelial cover in the absence of a scar with no dressing needed). The authors also investigated treatment change by group in terms of the proportion of participants changing from their allocated treatment to nontrial treatment before healing.


Median time to ulcer healing was 99 days (95% confidence interval [CI], 84-126) in the hosiery group and 98 days (95% CI, 85-112) in the bandage group; 150 of 454 (33%) participants changed to a nontrial treatment before their ulcers healed, and more did so in the hosiery group (88/230 [38%]) than in the bandage group (62/224 [28%]), p = 0.02. Average mean costs were approximately US$1.62 lower per participant per year in the hosiery group than in the bandage group.


The authors concluded that in the treatment of venous leg ulcers, two-layer compression hosiery is a feasible alternative to four-layer compression bandages that may be cost-effective.


Two-layer hosiery may be a feasible alternative to four-layer compression bandages for select patients with venous ulcers. Increased use of two-layer hosiery in patients in whom it is suitable (i.e., those who could apply or remove it) may be associated with significant cost savings.

Keywords: Compression Bandages, Cost Savings

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