title: The cost of prevention and treatment of pressure ulcers: A systematic review.
abstract: BACKGROUND
  Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating pressure ulcers and their impact on patients, healthcare, and society.
  
  
  OBJECTIVE
  The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population.
  
  
  METHODS
  A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies.
  
  
  RESULTS
  In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013. Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes.
  
  
  CONCLUSIONS
  Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention to patients at risk can importantly impact health care services' budgets, the costs to treat a severe pressure ulcer were found to be substantially higher. Methodological heterogeneity among studies identified the need to use available, and study design-specific methodological guidelines to conduct health economic studies, and the need for additional pressure ulcer specific recommendations.
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; AZ Sint-Elisabeth Hospital, Zottegem, Belgium. Electronic address: Liesbet.demarre@gmail.com.
authors.forename: Liesbet
authors.initials: L
authors.lastname: Demarré
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Van Lancker
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Hecke
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Verhaeghe
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Maria
authors.initials: M
authors.lastname: Grypdonck
authors.affiliation: Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium.
authors.forename: Juul
authors.initials: J
authors.lastname: Lemey
authors.affiliation: Health Economics, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Brussels University, ICHER (Interuniversity Center for Health Economics Research), Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK; Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Beeckman
mesh_terms: D017281:Cost of Illness; D006801:Humans; D003668:Pressure Ulcer / Q000191:economics* / Q000517:prevention & control / Q000628:therapy
keywords: Costs and cost analysis; Pressure ulcers; Prevention; Systematic review; Treatment