title: Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis.
abstract: OBJECTIVE
  Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients.
  
  
  METHODS
  Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon.
  
  
  RESULTS
  The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was $0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of $32 per patient. If decisionmakers are willing to pay $50,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses ($3,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty.
  
  
  CONCLUSIONS
  The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs.
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada. ba.pham@theta.utoronto.ca
authors.forename: Ba'
authors.initials: B
authors.lastname: Pham
authors.forename: Laura
authors.initials: L
authors.lastname: Teague
authors.forename: James
authors.initials: J
authors.lastname: Mahoney
authors.forename: Laurie
authors.initials: L
authors.lastname: Goodman
authors.forename: Mike
authors.initials: M
authors.lastname: Paulden
authors.forename: Jeff
authors.initials: J
authors.lastname: Poss
authors.forename: Jianli
authors.initials: J
authors.lastname: Li
authors.forename: Luciano
authors.initials: L
authors.lastname: Ieraci
authors.forename: Steven
authors.initials: S
authors.lastname: Carcone
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D001513:Beds / Q000191:economics*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D006699:Home Care Services / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D011788:Quality of Life