Are labour-intensive efforts to prevent pressure ulcers cost-effective?
BACKGROUND
Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13-43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement.


OBJECTIVE
To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care.


METHODS
A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty.


RESULTS
Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was -€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)'s dominance for both prevented pressure ulcers and saved lives with the PUB.


CONCLUSIONS
This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care.


CONCLUSIONS
The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.
Danish Center for Health Care Improvement, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University , Aalborg , Denmark.
Anne Sofie Mølbak
AS
Mathiesen
Kamilla
K
Nørgaard
Marie Frederikke Bruun
MF
Andersen
Klaus Meyer
KM
Møller
Lars Holger
LH
Ehlers
D003152:Community Health Nursing / Q000191:economics*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003661:Decision Support Techniques; D003663:Decision Trees; D003718:Denmark / Q000453:epidemiology; D004469:Economics, Hospital; D017048:Health Care Costs / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D011336:Probability; D059039:Standard of Care / Q000191:economics; D013997:Time Factors