title: Preventing pressure ulcers in long-term care: a cost-effectiveness analysis.
abstract: BACKGROUND
  Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities.
  
  
  METHODS
  We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84).
  
  
  RESULTS
  Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2).
  
  
  CONCLUSIONS
  The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.
authors.affiliation: TorontoHealth Economics and Technology Assessment Collaborative,Department of Health Policy Management andEvaluation, University of Toronto, 144 College Street, Toronto, Ontario, Canada. ba.pham@theta.utoronto.ca
authors.forename: Ba'
authors.initials: B
authors.lastname: Pham
authors.forename: Anita
authors.initials: A
authors.lastname: Stern
authors.forename: Wendong
authors.initials: W
authors.lastname: Chen
authors.forename: Beate
authors.initials: B
authors.lastname: Sander
authors.forename: Ava
authors.initials: A
authors.lastname: John-Baptiste
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bayoumi
authors.forename: Márcio
authors.initials: M
authors.lastname: Machado
authors.forename: Steven
authors.initials: S
authors.lastname: Carcone
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001513:Beds / Q000191:economics / Q000592:standards; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008297:Male; D044623:Nutrition Therapy / Q000191:economics / Q000592:standards; D003668:Pressure Ulcer / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D017592:Skin Care / Q000191:economics / Q000592:standards