A cost-effectiveness analysis of pressure ulcer prevention strategies

January 01, 0001

A cost-effectiveness analysis of pressure ulcer prevention strategies

These Canadian authors evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. They used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84).

They found: "Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78,000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50,000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2)."

The authors concluded: "The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence."

It makes sense to implement the cost-reducing strategies broadly.

For the full abstract, click here.

Arch Intern Med 171(20):1839-1847, 14 November 2011 © 2011 to the American Medical Association
Preventing Pressure Ulcers in Long-term Care: A Cost-effectiveness Analysis. Ba' Pham, Anita Stern, Wendong Chen, et al. Correspondence to Dr. Pham: ba.pham@theta.utoronto.ca

Category: S. Skin. Keywords: pressure ulcers, prevention, long-term care, cost-effectiveness analysis, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.