Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis. | Read by QxMD (original) (raw)

Ba' Pham, Laura Teague, James Mahoney, Laurie Goodman, Mike Paulden, Jeff Poss, Jianli Li, Luciano Ieraci, Steven Carcone, Murray Krahn

STUDY OBJECTIVE: Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients.

METHODS: Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon.

RESULTS: The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was 0.30perpatient.Comparedwithcurrentpractice,earlypreventionwasmoreeffective,with0.0015quality−adjustedlife−daysgained,andlesscostly,withameancostsavingof0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of 0.30perpatient.Comparedwithcurrentpractice,earlypreventionwasmoreeffective,with0.0015quality−adjustedlife−daysgained,andlesscostly,withameancostsavingof32 per patient. If decisionmakers are willing to pay 50,000perquality−adjustedlife−yeargained,earlypreventionwascost−effectiveevenforshortEDstay(ie,1hour),lowhospital−acquiredpressureulcerrisk(150,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses (50,000perquality−adjustedlife−yeargained,earlypreventionwascost−effectiveevenforshortEDstay(ie,1hour),lowhospital−acquiredpressureulcerrisk(13,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty.

CONCLUSION: The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs.