Loading...
The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial
Whitty, Jennifer A. McInnes, Elizabeth Bucknall, Tracey Webster, Joan Gillespie, Brigid M. Banks, Merrilyn Thalib, Lukman Wallis, Marianne Cumsille, Jose Roberts, Shelley
Whitty, Jennifer A.
McInnes, Elizabeth
Bucknall, Tracey
Webster, Joan
Gillespie, Brigid M.
Banks, Merrilyn
Thalib, Lukman
Wallis, Marianne
Cumsille, Jose
Roberts, Shelley
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 28 days; 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.
Keywords
cluster randomised trial, cost-effectiveness, economic evaluation, nursing interventions, pressure ulcer prevention
Date
2017
Type
Journal article
Journal
International Journal of Nursing Studies
Book
Volume
75
Issue
Page Range
35-42
Article Number
ACU Department
Nursing Research Institute
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
CC BY-NC-ND 4.0
File Access
Open