Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-19T23:21:46.741Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of pressure-relieving devices for the prevention and treatment of pressure ulcers

Published online by Cambridge University Press:  04 August 2005

Rachael L. Fleurence
Rachael L. Fleurence
Affiliation:
The MEDTAP Institute at UBC
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The cost-effectiveness of alternating pressure-relieving devices, mattress replacements, and mattress overlays compared with a standard hospital (high-specification foam mattress) for the prevention and treatment of pressure ulcers in hospital patients in the United Kingdom was investigated.

Methods: A decision-analytic model was constructed to evaluate different strategies to prevent or treat pressure ulcers. Three scenarios were evaluated: the prevention of pressure ulcers, the treatment of superficial ulcers, and the treatment of severe ulcers. Epidemiological and effectiveness data were obtained from the clinical literature. Expert opinion using a rating scale technique was used to obtain quality of life data. Costs of the devices were obtained from manufacturers, whereas costs of treatment were obtained from the literature. Uncertainty was explored through probabilistic sensitivity analysis.

Results: Using £30,000/QALY (quality-adjusted life year) as the decision-maker's cut off point (the current UK standard), in scenario 1 (prevention), the cost-effective strategy was the mattress overlay at 1, 4, and 12 weeks. In scenarios 2 and 3, the cost-effective strategy was the mattress replacement at 1, 4, and 12 weeks. Standard care was a dominated intervention in all scenarios for values of the decision-maker's ceiling ratio ranging from £5,000 to £100,000/QALY. However, the probabilistic sensitivity analysis results reflected the high uncertainty surrounding the choice of devices.

Conclusions: Current information suggests that alternating pressure mattress overlays may be cost-effective for the prevention of pressure ulcers, whereas alternating pressure mattress replacements appears to be cost-effective for the treatment of superficial and severe pressure ulcers.

Keywords

Pressure ulcerBedsCost-effectivenessDecision analysisStochastic process
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 3 , July 2005 , pp. 334 - 341
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allcock N, Wharrad H, Nicolson A. Interpretation of pressure-sore prevalence. J Adv Nurs. 994; 20: 37– 45.
Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med. 997; 13: 421– 436.
Allman RM, Walker JM, Hart MK, et al. 1987 Air-fluidized beds or conventional therapy for pressure sores. A randomized trial. Ann Intern Med. 107: 641– 648.Google Scholar
Bennett G, Dealey C, Posnett J. 2004 The cost of pressure ulcers in the UK. Age Ageing. 33: 230– 235.Google Scholar
Berlowitz DR, Wilking SV. 1990 The short-term outcome of pressure sores. J Am Geriatr Soc. 38: 748– 752.Google Scholar
Bradley M, Cullum N, Nelson EA, et al. 1999 Systematic reviews of wound care management: (2). Dressings and topical agents used in the healing of chronic wounds. Health Technol Assess. 3 (Pt 2): 1– 35.Google Scholar
Bradley M, Cullum N, Sheldon T. 1999 The debridement of chronic wounds: A systematic review. Health Technol Assess. 3 (Pt 1): 1– 78.Google Scholar
Brandeis GH, Morris JN, Nash DJ, Lipsitz LA. 1990 The epidemiology and natural history of pressure ulcers in elderly nursing home residents. JAMA. 264: 2905– 2909.Google Scholar
Briggs AH. 2000 Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 17: 479– 500.Google Scholar
Clark M. 2001. Pressure ulcer prevention. In: Morison M, ed. The prevention and treatment of pressure ulcers. Edinburgh: Harcourt Health Sciences;
Clark M. 2002 Pressure ulcers and quality of life. Nurs Stand. 16: 74– 80.Google Scholar
Clark M, Benbow M, Butcher M, et al. 2002 Collecting pressure ulcer prevention and management outcomes: 1. Br J Nurs. 11: 230, 232, 234 passim.Google Scholar
Clark M, Benbow M, Butcher M, et al. 2002 Collecting pressure ulcer prevention and management outcomes: 2. Br J Nurs. 11: 310– 314.Google Scholar
Clark M, Cullum N. 1992 Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses. J Adv Nurs. 17: 310– 316.Google Scholar
Clark M, Watts S. 1994 The incidence of pressure sores within a National Health Service Trust hospital during 1991. J Adv Nurs. 20: 33– 36.Google Scholar
Claxton K. 1999 The irrelevance of inference: A decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 18: 341– 364.Google Scholar
Claxton K, Ginnelly L, Sculpher M, Philips Z, Palmer S. 2004 A pilot study on the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment programme. Health Technol Assess. 8: 1– 103.Google Scholar
Claxton K, Neumann PJ, Araki SS. 2001 The value of information: An application to a policy model of Alzheimer's disease. Int J Technol Assess Health Care. 17: 38– 55.Google Scholar
Cullum N, Nelson EA, Flemming K, Sheldon T. 2001 Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 5 (9): 1– 221.Google Scholar
Dealey C. 1991 The size of the pressure-sore problem in a teaching hospital. J Adv Nurs. 16: 663– 670.Google Scholar
Department of Health. Hospital Episode Statistics England Financial Year 2002–2003. London: Department of Health.
Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ. 1985 Probabilistic sensitivity analysis using Monte Carlo simulation. Med Decis Making. 5: 157– 177.Google Scholar
Drummond MF, Torrance GW, Stoddart GL. 1995. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press;
Felli JC, Hazen GB. 1998 Sensitivity analysis and the expected value of perfect information. Med Decis Making. 18: 95– 109.Google Scholar
Fenwick E, Claxton K, Sculpher M. 2001 Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 10: 779– 787.Google Scholar
Ferrell BA, Osterweil D, Christenson P. 1993 A randomized trial of low-air-loss beds for treatment of pressure ulcers. JAMA. 269: 494– 497.Google Scholar
Franks PJ. 2001. Health economics: The cost to nations. In: Morison M, ed. The prevention and treatment of pressure ulcers. Edinburgh: Harcourt Health Sciences;
Franks PJ, Collier ME. Quality of life: The cost to the individual. In: Morison M, ed. The prevention and treatment of pressure ulcers. Edinburgh: Harcourt Health Sciences; 2001.
Franks PJ, Winterberg H, Moffatt CJ. 2002 Health-related quality of life and pressure ulceration assessment in patients treated in the community. Wound Repair Regen. 10: 133– 140.Google Scholar
Gebhardt KS, Bliss MR, Winwright PL, Thomas J. 1996 Pressure-relieving supports in an ICU. J Wound Care. 5: 116– 121.Google Scholar
Gold MR, Siegel JE, Russell LB, et al. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press;
Hanson R. 1997 Sore points sorted. Nursing Times. 93: 68– 72.Google Scholar
Kaltenthaler EC. 2001 UK, USA and Canada: How do their pressure ulcer prevalence and incidence data compare? J Wound Care. 10: 530– 535.Google Scholar
Krahn MD, Naglie G, Naimark D, Redelmeier DA, Detsky AS. 1997 Primer on medical decision analysis: Part 4—Analyzing the model and interpreting the results. Med Decis Making. 17: 142– 151.Google Scholar
Lyder CH. 2003 Pressure ulcer prevention and management. JAMA. 289: 223– 226.Google Scholar
McInnes E. 2004 The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. J Tissue Viability. 14: 4– 6, 8, 10.Google Scholar
Miller DK, Homan SM. 1994 Determining transition probabilities: Confusion and suggestions. Med Decis Making. 14: 52– 58.Google Scholar
National Collaborating Centre for Nursing & Supportive Care. 2003. Clinical practice guidelines for pressure-relieving devices. London: National Institute for Clinical Excellence;
Nelson EA, Nixon J, Mason S, et al. 2003 A nurse-led randomised trial of pressure-relieving support surfaces. Prof Nurse. 18: 513– 516.Google Scholar
O'Dea K. 1993 Prevalence of pressure damage in hospital patients in the UK. J Wound Care. 2: 221– 225.Google Scholar
O'Dea K. 1999 The prevalence of pressure damage in acute care hospital patients in the UK. J Wound Care. 8: 192– 194.Google Scholar
O'Meara S, Cullum N, Majid M, Sheldon T. 2000 Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assess. 4: 1– 237.Google Scholar
Raftery J. 2001 NICE: Faster access to modern treatments? Analysis of guidance on health technologies. BMJ. 323: 1300– 1303.Google Scholar
St Clair M, Cooper S, Gebhardt K. 1995 Tissue viability. Measuring pressure sore incidence: A study. Nurs Stand. 9: 50– 51.Google Scholar
Thomson JS, Brooks RG. 1999 The economics of preventing and treating pressure ulcers: A pilot study. J Wound Care. 8: 312– 316.Google Scholar
Torrance C, Maylor M. 1999 Pressure sore survey: Part One. J Wound Care. 8: 27– 30.Google Scholar
Townsend J, Buxton M, Harper G. 2003 Prioritisation of health technology assessment. The PATHS model: Methods and case studies. Health Technol Assess. 7: 1– 82.Google Scholar
Van Hout BA, Al MJ, Gordon GS, Rutten FFH. 1994 Costs, effects and C/E ratios alongside a clinical trial. Health Econ. 3: 309– 319.Google Scholar
Williams S, Watret L, Pell J. 2001 Case-mix adjusted incidence of pressure ulcers in acute medical and surgical wards. J Tissue Viability. 11: 139– 142.Google Scholar