Economic evaluation. Cost-effectiveness of nutritional intervention on healing of pressure ulcers.
1. Cost-effectiveness of
nutritional intervention on
healing of pressure ulcers
Akinori Hisashige
Institute of Healthcare Technology
Assessment, Japan
Takehiko Ohura
Pressure Ulcers and Wound Healing
Research Center, Japan
1
4. Burden of Pressure Ulcers
Prevalence rate
US, UK, Can
Hospitals 4.7 ~ 32.1%
Nursing homes 4.6 ~ 20.7%
Community care 4.4 ~ 33.0%
Japan
General hospitals2.2 ~ 3.3%
Long-term care 2.5%
Nursing care 8.3%
4
5. Economic burden of Pressure Ulcers
Annual costs for treatment of
pressure ulcers
UK £ 750 million
US $ 3 billion
Australia A$ 285 million
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6. Evidence for Nutritional Interventions
on Pressure Ulcers
JAMA, 2006, 2008
Prevention
Dietary supplementation: maybe beneficial
5 RCTs
One high quality trial: effective
Other trials: not effective
Healing
Nutritional supplementation: maybe beneficial
7 RCTs
One high quality trial: effective
Other trials: mixed results
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9. Nutritional intervention
Mean daily calorie per person
Intervention Control t p
During observation (12w)
1,384 (166) 1,092 (162) 6.226 .0000
Follow-up (4W)
1,142 (238) 1,094 (188) .851 .4019
Kcal: Mean (SD)
The goal energy for intervention =
Basal Energy Expenditure x active factor (1.1) x stress factor
(1.3-1.5) 9
12. Utility value for pressure ulcers
Design: cross-sectional survey
Subjects: 227 members of Japanese Society of
Pressure Ulcers
Method: TTO (time trade-off), group interview
Results:
Utility for bed-ridden 0.39
Utility for bed-ridden + pressure ulcer
0.30
Utility for pressure ulcer - 0.086
(SD) (0.012)
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13. Health state utilities
Healthy (reference state) 1.00
Menopausal symptoms 0.99
Side effects of hypertension treatment 0.95
Mild angina 0.90
Kidney transplant 0.84
Moderate angina 0.70
Hospital dialysis 0.56
Severe angina 0.50
Anxious/depressed and lonely much of the time 0.45
Being blind or deaf or dumb 0.39 Bed-ridden
Hospital confinement 0.33
Mechanical aids to walk and learning disabled 0.31 Bed-ridden
Dead (reference state) 0 +
pressure ulcer
Confined to bed with severe pain -
Unconscious - 13
14. Incremental effectiveness of
nutritional intervention per person
Effectiveness Intervention Control Incremental effectiveness
(95% CI)
PUDs
84.6 100.8 -16.2 (-8.7 ~ -23.7)
QALYs (x10 - 2 )
-2.00 -2.38 0.382 (0.205 ~ 0.559)
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23. Cost-effectivene ss of prevention and treatment
Russell, Health Aff, 28, 2009
QALY = quality-adjusted life-year
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24. Conclusion
Nutritional intervention on healing
pressure ulcers is cost saving with
health improvement.
Further studies are required to
determine whether this is a cost-
effective intervention for widespread
use.
24
09 Copenhagen prevention May 09/21/12 In this chart, the proportions across the preventive measures and across the interventions add to 100; the chart shows what proportions are cost saving, of different degrees of cost effectiveness, and those that actually worsen health. Only about 70% of all recommended interventions are cost effective at conventional levels (less than $50,000 per QALY), 10 to 15% are borderline, and the rest (about 20%) cannot be justified either by cost or by evidence of benefit. Preventive interventions are no more likely to be justified by cost effectiveness than are treatments for existing conditions. Source: Russell LB. Preventing chronic disease: an important investment, but don't count on cost savings. Health Aff 2009;28:42-5.