Resource impact summary report
Resource impact summary report
This summary report is based on the NICE assumptions used in the cost calculator. Users can amend the 'Inputs and decisions' worksheet in the template to reflect local data and assumptions.
Recommendations
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When choosing compression products to treat venous leg ulcers, price variation for compression hosiery over compression bandaging is justified, provided that the hosiery is clinically appropriate and meets the needs and preferences of the person with a venous leg ulcer.
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Price variation for compression wraps over other compression products is not justified unless a compression wrap is the only suitable option.
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See sections 1.3 to 1.4 of the guidance for the other recommendations.
Resource impact (cash and capacity items)
NICE has developed a cost calculator to help healthcare professionals estimate the total overall cost of use of the clinically appropriate compression product options using local data to establish and select the least expensive option.
The overall resource impact will depend on the difference in total treatment cost per person between the clinically appropriate treatment options based on:
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the unit cost of the compression product
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the quantity of the compression products needed over the treatment duration
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the number of visits by healthcare staff to change the compression product, the time required for each visit (including travel time) and their associated pay band. Users can amend the % of direct patient care for the relevant pay band, within the payscales tab, to ensure the correct hourly cost is used
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the duration of treatment or time to healing
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the supplementary products needed.
The clinical presentation of each person can vary, so the requirements of care will vary from person to person. The cost calculator can be used on a per-person basis to estimate the treatment pathway costs, using a suitable selection of compression products. The treatment pathway options are ranked by increasing cost. The user guide worksheet provides information on how to use the cost calculator.
To model costs for a service or case load, users can enter the anticipated number of patients for the case mix under consideration. The cost for this number of patients will be estimated for each of the different treatment pathways.
Capacity impact
Economic modelling suggests that compression hosiery, which enables self-management, is cost effective compared with compression bandaging, which relies on more frequent visits from a nurse to change the compression product. Capacity savings could be:
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fewer healthcare professional visits per week if hosiery, rather than bandaging, is used
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freeing up of band 5 nurse time if hosiery, rather than bandaging, is used. Hosiery requires visits by a band 3 or 4 staff, whereas bandaging requires a band 5 nurse.
Consultation comments suggest that in some areas locally trained or competent band 3 or 4 healthcare staff can apply compression bandaging. So, the capacity impact would only be the time taken to apply bandages compared with hosiery.
Because the guidance does not recommend any type of compression product over the others, any capacity saving will depend on local wound management policies.
Treatment options for venous leg ulcers
There are many compression products available to the NHS. NICE considered compression products listed on the NHS Drug Tariff Part IX. Four types of compression products are used to treat venous leg ulcers in the NHS:
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4-layer compression bandaging
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2-layer compression bandaging
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2-layer compression hosiery
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compression wraps.
Procurement of the compression products is through routes such as the NHS prescription services for primary care, NHS Supply Chain and off medical prescription procurement platforms. This also includes procurement of supplementary products, such as hosiery applicators, bandage overshoes, waterproof bandage protectors and other items that may be needed.
Eligible population for compression ulcers
Venous leg ulcers account for 60% to 80% of all leg ulcers. The prevalence estimates for venous leg ulcers range from a point prevalence of 0.03% (Urwin et al. 2022) to an estimated annual prevalence of 1.08% (Guest et al. 2020).
Key information
| Speciality area |
Multiple specialities |
|---|---|
| Disease area |
Leg ulcers |
| Programme budgeting category |
PBC14X: Problems of the Skin |
| Pathway position |
Management |
| Commissioner(s) |
Integrated care boards |
| Provider(s) |
Primary care, Community health care, Secondary care (acute and ambulance services) |
About this resource impact summary report
This resource impact summary report accompanies the NICE late-stage assessment guidance on compression products for treating venous leg ulcers and should be read with it.
ISBN: 978-1-4731-7181-7
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