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Published (Version of record)CC BY-NC-ND V4.0, Open
Journal article
The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial
International Journal of Nursing Studies, Vol.75, pp.35-42
10/2017
PMID: 28711725
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Abstract
Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare.
To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care.
Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial.
Eight tertiary hospitals in Australia.
Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799).
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).
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.
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.
Details
- Title
- The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial
- Creators
- Jennifer A Whitty (Author) - Griffith UniversityElizabeth McInnes (Author) - Australian Catholic UniversityTracey Bucknall (Author) - Griffith UniversityJoan Webster (Author) - Griffith UniversityBrigid M Gillespie (Author) - Griffith UniversityMerrilyn Banks (Author) - Royal Brisbane HospitalLukman Thalib (Author) - Qatar UniversityMarianne Wallis (Author) - Griffith UniversityJose Cumsille (Author) - University of QueenslandShelley Roberts (Author) - Griffith UniversityWendy Chaboyer (Author) - Griffith University
- Publication Details
- International Journal of Nursing Studies, Vol.75, pp.35-42
- Publisher
- Elsevier Ltd
- Identifiers
- 991012927100302368
- Copyright
- © 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).MARK
- Academic Unit
- Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article