The cost-effectiveness of interventions for preventing pressure ulcers.

BACKGROUND While there is scientific evidence to support the efficacy of preventive interventions for pressure ulcers, few empirical data are available on their cost-effectiveness. The aim of this study was to determine the cost-effectiveness of interventions to prevent pressure ulcers. METHODS Cost of preventive interventions and days of ulcer-free survival were compared for two groups of patients. One group consisted of 250 patients from a geriatric unit of a British hospital (Norton sample). At the time of the study, no preventive measures were used. Data from the original report of the study were used to determine patients' attainment of one of three end points--ulcer formation, death, or discharge--from which a disease-free survival table was constructed. The second cohort of 420 patients consisted of residents of a long-term care facility in Iowa, where aggressive preventive measures were used (Iowa sample). Data were collected at the study onset and 3 months later. The types of preventive interventions used on each patient were assessed and their costs calculated. Cost of treatment for pressure ulcers was estimated from previous research performed at the Iowa facility. The cost-effectiveness of the preventive intervention was calculated by dividing the mean difference in cost between the two groups by mean difference in ulcer-free days. RESULTS Survival analysis of days to ulcer development showed the Norton (no prevention) sample had a significantly shorter time to ulcer development than did Iowa sample (patients receiving preventive measures) (P < 0.0001). The mean cost for prevention and treatment of an ulcer was $167 +/- $307 for the Norton sample and $245 +/- $379 for the Iowa sample. The mean number of ulcer-free days was 21.0 -/+ 17.4 for the Norton sample and 78.5 +/- 11.0 for the Iowa sample. The cost per day of ulcer-free life gained was $1.36. CONCLUSION The use of aggressive preventive measures in the long-term care setting is effective in reducing pressure ulcers and requires a relatively low level of institutional expenditures.