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Cost-effectiveness of a pressure ulcer quality collaborative

DOI: 10.1186/1478-7547-8-11

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Abstract:

We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained.Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained.During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.A pressure ulcer (PU) is a preventable condition that affects patients with impaired mobility, especially the elderly [1]. PUs are classified from grades 1 to 4, or least to most severe. The average prevalence of PUs in the Netherlands is 7.9% in assisted living homes and 18.3% in nursing homes [2]. Incidence varies between 2.9% and 4.5% in intensive care [3]. No incidence data are available for the Dutch long-term care sector. The probability of healing within 90 days varies with severity: 67% (grade 2), 44% (grade 3) and 32% (grade 4) [4]. PUs can interfere with recovery, cause pain

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