title: Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later.
abstract: BACKGROUND
  Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI).
  
  
  METHODS
  The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures.
  
  
  RESULTS
  Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million.
  
  
  CONCLUSIONS
  Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.
authors: Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia, haitham.tuffaha@griffith.edu.au.
authors: Haitham W
authors: HW
authors: Tuffaha
authors: Shelley
authors: S
authors: Roberts
authors: Wendy
authors: W
authors: Chaboyer
authors: Louisa G
authors: LG
authors: Gordon
authors: Paul A
authors: PA
authors: Scuffham
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008390:Markov Chains; D009010:Monte Carlo Method; D018529:Nutritional Support / Q000191:economics*; D003668:Pressure Ulcer / Q000401:mortality / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors