Advice
The technology
The technology
Coban 2 compression bandage system (3M) is a multilayer compression bandage for treating venous leg ulcers. It has 2 layers: a polyurethane foam inner layer for padding; and an outer layer of elastic and short-stretch fibres for therapeutic compression. It is suitable for people with an ankle brachial pressure index (ABPI) of 0.8 or higher. Coban 2 Lite exerts less pressure and is suitable for people with an ABPI higher than 0.5. Coban 2 Lite can be used in people who can't have or don't want full compression. The layers have a cohesive backing that fuses them together into a stiff sleeve, which is designed to reduce slipping. It is latex free and may be worn for up to 7 days.
Innovations
Coban 2 is thinner than standard 4‑layer bandages, which is designed to allow patients to have better mobility and to allow a greater choice of shoes to be worn. In addition, the proprietary materials are designed to minimise slipping between the dressing layers.
Current care pathway
The NICE clinical knowledge summary on venous leg ulcers recommends that a professional with expertise in wound management is involved in the person's care (such as a district nurse or tissue viability nurse). Compression therapy should be given to all people with non-infected venous leg ulcers with an ABPI of 0.8 or higher. When compression therapy is used, it should be tailored to the person. This includes a considering that a 2‑layer bandage is, compared to a 3- or 4‑layer bandage, more practical for people who are mobile.
Population, setting and intended user
Most people with venous leg ulcers are treated in the community. Coban 2 would be applied by practice or community nurses, with support from tissue viability specialists, and would be used instead of 4‑layer bandages. Healthcare providers already trained in multilayer compression bandaging would need a short training session but no organisational changes are likely to be needed.
Costs
Technology costs
Table 1 Technology costs and costs of standard care
|
Description |
Cost |
Additional information |
|
Coban 2 |
£8.24 |
Bandages must be replaced weekly by a trained healthcare professional. |
|
Coban 2 Lite |
£8.24 |
|
|
Profore |
Ankle circumference <18 cm, £13.38; 18 cm to 25 cm, £9.54; 25 cm to 30 cm, £10.19; above 30 cm, £15.11. |
|
|
Urgo K-Four 4-layer compression bandage |
Ankle circumference <18 cm, £6.73; 18 cm to 25 cm, £6.44; 25 cm to 30 cm, £6.44; above 30 cm, £8.87; reduced compression 18 cm and above, £4.21. |
Resource consequences
Several company-sponsored studies on the resource consequences of Coban 2 were identified, which suggest that is cost saving compared with 2‑layer compression bandages such as UrgoKTwo and Profore. The largest and most relevant resource study, Guest et al. (2017) showed that Coban 2 was cheapest in terms of community nurse visits, analgesics and anti-infectives compared with UrgoKTwo and Profore over 6 months in the NHS (data from THIN database). This study also recorded that time to healing was significantly less for Coban 2 than for UrgoKtwo and Profore and that health-related quality of life was highest in the Coban 2 group at 0.413 quality-adjusted life years (QALY) compared with 0.404 for Ktwo and 0.396 for Profore. This study was funded by a research grant from the company, 3M. Up to 23% people switched compression therapy treatments during the study period and this was not accounted for in the analyses. Participants were not blinded or randomised.
The specialist commentators stated that the main drivers of costs for compression bandaging were staff training and staff time.
Coban 2 kits come in 1 size, intended to fit all leg sizes and is latex free. Coban 2 would represent a small additional costs compared with standard 4‑layer dressing which would likely be offset if it promoted better compliance with compression bandaging.
The company has stated that Coban 2 is in use in 15 NHS organisations.