Compression products for treating venous leg ulcers: late-stage assessment

Compression products squeeze the lower limb to reduce oedema (swelling) and help blood flow back to the heart. Compression products can vary in the level of pressure applied. Strong compression, that is compression designed to give at least 40 mmHg of pressure at the ankle, is recommended for venous leg ulcers. This can be elastic, inelastic or a combination compression system. The scope of this assessment includes only compression products that aim to deliver at least 40 mmHg of pressure at the ankle and are used for treating venous leg ulcers. It does not include:

• made-to-measure compression hosiery, which is used for maintenance compression after ulcers have healed, or

• compression products that are used before or after surgery.

Four types of compression products are used to treat venous leg ulcers in the NHS:

• 4‑layer compression bandaging

• 2‑layer compression bandaging

• 2‑layer compression hosiery

• compression wraps.
  
  The focus of this assessment is the difference in clinical and cost effectiveness between the types of compression product. The variation of features within a product type (colour, marking) was expected to have less impact on their effectiveness, so are excluded from the assessment.

At least 20 companies provide over 200 compression products (of different sizes, products and colours) to the NHS through a range of procurement routes. There are also many supplementary products, such as hosiery applicators, bandage overshoes and boots to protect bandages when showering, to support people using a compression product. For this assessment, NICE considered compression products listed on the NHS Drug Tariff Part IX.