Specialist commentator comments

Comments on this technology were invited from 4 clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Two specialists reported using Coban 2 (and other bandages) routinely; another specialist had not used Coban 2 but was familiar with the technology and other compression bandage systems; the fourth specialist had used Coban 2 but does not use it currently.

Level of innovation

All 4 specialists stated that Coban 2 is a minor variation of other short-stretch compression bandages. Two specialists noted that the foam layer was unique to Coban 2. One stated that the layers do not slip over each other, improving comfort for the wearer. One specialist noted that Coban 2 is best suited to ulcers with relatively little exudate because it only has 2 layers; more absorbent 4‑layer bandages are better for ulcers with large amounts of exudate. One specialist stated that other bandages are not materially different to Coban 2. One specialist stated that 2 layers of bandaging is easier to apply than 4. They also noted that as Coban 2 can be adjusted as the person's ankle circumference decreases, rather than having to order a new size.

Potential patient impact

One specialist stated that Coban 2 could offer greater comfort for some people and therefore improve compliance to compression therapy. One specialist noted that people wearing Coban 2 will feel that their bandages are the correct size. Three specialists state that this is particularly relevant for people leading an active lifestyle and those who work. These specialists stated that Coban 2 was resistant to slipping and could be worn with a greater choice of shoes. The specialist also stated that Coban 2 might minimise time off work for people needing treatment for venous leg ulcers. This is because they might feel more comfortable and are able to wear their usual shoes. One specialist stated that using Coban 2 could lead to improved ulcer healing and oedema reduction.

Potential system impact

One specialist stated that Coban 2 could reduce clinic and hospital visits because of reduced oedema, exudate and bandage slip and improved compliance. This specialist also noted the potential cost savings from reducing the frequency of bandage application to once a week. They said that other bandages may need to be changed more often because of slipping. The specialist also noted that there is no need for prescription shoes to be worn with Coban 2. Two commentators stated that Coban 2 offered the same system benefits as other multilayer compression bandages. One specialist stated that hospital visits are unlikely to be reduced unless Coban 2 led to faster healing times.

Three specialists noted that there would be little or no change needed to the care pathway or to how services are delivered. The specialists advised that training is straightforward for staff already trained in compression bandaging. One specialist noted that any change in practice would need to be supported by new training and competency frameworks for tissue viability nurses delivering training for leg ulcer management in the community.

Two specialists stated that the cost of using Coban 2 is likely to be the same as any other compression bandage. One specialist stated that Coban 2 is likely to be more expensive than 4‑layer bandages (Profore) because of the higher purchase price.

General comments

Two experts noted that it is not possible to have a one-size-fits-all bandage that will accommodate all leg sizes. One specialist noted that much of the evidence for Coban 2 is funded by the company and that an independent trial comparing Coban 2 to 4-layer bandaging would be useful.