Time and Labor Costs of Compression Therapy Wrap System for Lower Extremity Edema: Results From a Single Center

The prevalence of lower extremity edema of all etiologies is nearly 20% among those over age 65 in the United States.¹ Patients experience significant pain, difficulty walking, and other physical impairments. The health care burden of managing lower extremity edema is nearly $5 billion per year or $7679 per treated patient per year.² This includes primary care visits, hospitalizations, wound care, and medication costs. While multilayer compression therapy is the standard of care for the management of lower-extremity edema, previous studies have noted that compression bandage systems can be time-consuming to apply and patient adherence is often poor.^3,4 However, these studies have not quantified the application time of compression bandage systems. A 2LB system has been shown to achieve similar or better outcomes and may increase adherence compared to a 4LB bandage system due to improved patient comfort.^5-7 However, the comparative medical time and labor costs associated with the application of 2LB and 4LB systems are unknown. The objective of this study was to assess the time and labor costs associated with the application of a 2LB versus 4LB compression therapy system.

The observational 2-group post-test study took place at a single high-volume wound care center located in Dayton, Ohio, on a single day. All patients presenting with lower-extremity edema of all etiologies who were indicated for or recommended to have compression therapy by the treating physician were included in the study. Patients were assigned to 2LB or 4LB in a 1:1 manner through the course of the day. The 2LB system was the Urgo K2 2-layer compression system (Urgo Medical North America), and the 4LB system was the PROFORE multilayer compression bandaging system (Smith and Nephew).  

The compression systems were applied by 1 of 3 medical technicians who had been previously trained and deemed proficient by the physician with the application of both bandage systems. All patients and products were positioned in the same manner before the timing was started. The timer was started at the opening of the wrap kit and stopped at the completion of the application of a single limb wrap, and an independent observer timed the wrap application. The time for primary and secondary dressings was not included. 

The time per application was summarized for each cohort and reported as mean, standard deviation, 25th percentile, median, 75th percentile, minimum, and maximum. A 2-tailed t test was performed to assess the statistical significance of the difference. Alpha was set at 0.05. The average hourly wage of the 3 medical technicians plus a 30% overhead rate was multiplied by the application time to determine the labor cost associated with the compression wrap application, with the 30% overhead rate representing the center’s overhead rate. The study received a waiver from the institutional review board. 

A total of 38 patients (2LB cohort = 19; 4LB cohort = 19) received a compression wrap. The average time per application was 1:05 and 2:08 minutes (P > .001) for the 2LB and 4LB systems, respectively (Table). The average difference was 1:03 minutes per application, which totaled 19:57 minutes over the course of the day for 19 applications. The average time and corresponding cost to apply the 2LB system was approximately 50% less than a 4LB system (Figure). The average time and cost per patient were calculated from a 1:1 randomized sample of 38 patients. The 2LB system was associated with 50% less time and 52% reduced cost per application than the 4LB system. 

Application times for the 2LB system ranged from 0:55 minutes to 1:15 minutes, whereas times for the 4LB system ranged from 1:40 minutes to 4:12 minutes. The median application time was 1:05 and 1:58 minutes for the 2LB and 4LB systems, respectively. Total time of application during the day was 20:35 minutes and 40:32 minutes for 2LB and 4LB systems, respectively, over the course all patients.

The average labor cost including overhead was $26 per hour for the 3 medical technicians. The direct labor cost of applying a single limb compression wrap was $0.47 for the 2LB system and $0.93 for the 4LB system, representing a labor cost savings of 52%. Over the course of the day, the 2LB system reduced labor costs by $8.65 compared to the 4LB system (total cost $8.92 2LB vs $17.56 4LB).

At a high-volume wound care clinic in Dayton, Ohio, the application of a 2LB compression system resulted in substantial time and labor cost savings per application. The use of a 2LB system has been previously shown to provide similar patient outcomes and cost reductions compared to a 4LB system.^6,8 Therefore, the efficiency of compression therapy application time associated with a 2LB system is likely to increase value due to lower costs and similar outcomes.

The center at which this study was conducted typically sees about 940 patients with lower extremity edema indicated for compression therapy per month. If all extremities were wrapped with 2LB system, it would translate into labor cost savings of $427 and 16:27 hours per month. This added time creates several opportunities for a wound care clinic. First, for a high-volume center opportunity at capacity, it may represent an additional 65 patient visit opportunities (4 patients per hour) and translate into an additional $15 210 revenue per month based on the center’s average patient payment of $234 per visit. The use of the Medicare base payment for CPT 29580 would show a revenue gain of $6011 per month. However, most centers receive more than the Medicare base payment and have some commercial payers. Further, there is an opportunity to reduce staff overtime expenses or increase time spent with patients, which may lead to improved patient and staff satisfaction.⁹

A 2LB system also represents an opportunity to reduce the environmental impact of discarded bandage material and packaging. Health care waste—and bandages in particular—costs approximately $4.00 per kilogram to dispose of properly.¹⁰ This does not include the environmental impact from the manufacturing and transport of the compression bandage systems, and a 4LB uses more natural and synthetic (usually petrochemical-based) materials.¹¹ Therefore, the use of 2LB system rather than a 4LB system may lead to substantial environmental savings over the course of a year through reduced bandage material usage and disposal costs.

This study has several limitations that must be noted. First and foremost, this study represented a single center located in Dayton, Ohio. Second, it represented 1 clinical day and included all patients with lower extremity edema who were clinically indicated for compression therapy. This was not a randomized controlled trial. Third, it was an open-label study and blinding was not possible. As such, this study may not be generalizable to other settings. Fourth, the authors did not include a measure for the patient’s ability to assist with positioning during the application of the compression system, or the length and diameter of the patients’ legs. Finally, this study was limited to the compression system application time and corresponding labor costs applicable to a US health care system with the 2LB systems. Patient adherence, nurse quality of life, and outcome data were not collected.

To the authors’ knowledge, this was the first case study to quantify the associated time and labor cost reductions associated with a 2LB system. The study found substantial decreases in both time and labor costs associated with the 2LB system, which may create opportunities for additional revenue or cost savings compared to a 4LB system.