Jennifer A Whitty1, Elizabeth McInnes2, Tracey Bucknall3, Joan Webster4, Brigid M Gillespie5, Merrilyn Banks6, Lukman Thalib7, Marianne Wallis8, Jose Cumsille9, Shelley Roberts10, Wendy Chaboyer10. 1. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7JT, UK. Electronic address: Jennifer.whitty@uea.ac.uk. 2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, NSW 2060, Australia; Nursing Research Institute - Australian Catholic University and St Vincent's Health Australia Sydney, Darlinghurst, NSW 2010, Australia. 3. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC 3220, Australia; Alfred Health, Melbourne, VIC 3004, Australia. 4. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia. 5. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast University Hospital and Health Service, Southport, QLD 4215, Australia. 6. Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia. 7. Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar. 8. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia. 9. School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia. 10. National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
Abstract
BACKGROUND: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. OBJECTIVES: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. DESIGN:Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. SETTINGS: Eight tertiary hospitals in Australia. PARTICIPANTS: Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). METHODS: Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). RESULTS: The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. CONCLUSIONS: A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.
RCT Entities:
BACKGROUND: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. OBJECTIVES: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. DESIGN: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. SETTINGS: Eight tertiary hospitals in Australia. PARTICIPANTS: Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). METHODS: Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). RESULTS: The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. CONCLUSIONS: A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.
Authors: Henry Okonkwo; Ruth Bryant; Jeanette Milne; Donna Molyneaux; Julie Sanders; Glen Cunningham; Sharon Brangman; William Eardley; Garrett K Chan; Barbara Mayer; Mary Waldo; Barbara Ju Journal: Wound Repair Regen Date: 2020-01-21 Impact factor: 3.617