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Cost effectiveness analysis of an intervention to prevent pressure ulcers

Cost effectiveness analysis of an intervention to prevent pressure ulcers. MPH Health economics Spring 2012. Methodology. Method : Model: Decision tree , comparison with no intervention Uncertainty analysis (model/data) Input data: Based on observation ( litterature )+interview

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Cost effectiveness analysis of an intervention to prevent pressure ulcers

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  1. Costeffectivenessanalysis of an intervention to preventpressureulcers MPH Health economics Spring 2012

  2. Methodology • Method: • Model: Decision tree, comparisonwithno intervention • Uncertaintyanalysis (model/data) • Input data: Basedon observation (litterature)+interview • Measure of effectiveness: No of reducedpressureulcers, No of preventeddeaths • Costs: Directcost • Perspective: Societalperspective: Both hospital and homecarecostsareincluded.

  3. Epidemiology • It is estimatedthat 13-43 % of inpatients in Danish hospitals have a pressureulcer • 7-7,3% of theseareestimated to beacquiredduringhospitalization • Most pressureulcersarepreventableifappropriatemeasuresaretaken.

  4. Patophysiology • HAPU occurstypically under immobilisation • Pressureon the skin makes an ischaemia, whichultimatelycandevelop an ulcer • Pressureulcersaregradedinto 4 stages, where 4 is most severe.

  5. Guidelines to preventpressureulcers • To prevent hospital acquiredpressureulcers (HAPU), Dansk Selskab for Patientsikkerhed has developed a set of guidelines: • Risk screening of all new patients (Braden/NortonScale) except for womengivingbirth. • Patients at riskaredailyassessed for HAPU • Patients at riskarenutritionscreened • Patients at riskarerepositionedfrequently and get support surfaces • Target is to reduceHAPUswith 50 %

  6. Actions to prevent HAPU in a Danish surgicaldepartment • Hand-out of patient information: all patients, once per hospitalisation • Journal writing: all patients, once a day • Risk screening: all patients, once a day • Repositioning: at-risk patients, everysecondday • Notes in EPJ: at-risk patients, everysecondday

  7. Whyconduct a CEA study? • Prevention of HAPUstakeadditional time for nurses on the hospitals and in homecare – it is therefore not evident, that it is a good business to introduceprevention. New intervention more costly PREVENTION OF HAPUsbelow the maximum acceptable ICER? New intervention more effective New intervention lesseffective New intervention lesscostly

  8. Model: Descisiontree

  9. Costassessed in the hospital and in the primarysector • A healthsector (primary and secondary) perspective is chosen • Cost in hospital: • Added nurse time spentondocumentation, information and repositioning of patients • Specialmatresses, sheets, pillows, chairs • Education of nurses • Cost in primaryhealthcare • Home care nurses home visits

  10. Calculation of preventioncosts per patient (average LOS)

  11. Calculation of implementationcosts pr. stay per patient

  12. Total cost, prevention of HAPU at hospital

  13. Directcost of HAPU on hospitals

  14. Is it a good business for hospitals to preventHAPUs? • 50 % reduction => from 7 % to 3,5% of all patients • No of inpatients in DK hospitals minus obstetric patients: 1.203.746 (2010) • No of HAPUsprevented: 3,5 % eq. to 42.131 per year • No of deathsprevented: Mortality rate*50%: 2.211 per year • Cost of intervention x inpatient/year= 284.206.606 DKK • Gain for HAPUssaved x 3,5% of patients = 7.068.445 DKK • Conclusion: No, it is not a good business: More expensive for hospitals to preventHAPUsthan to leave the patients with standard treatment.

  15. Whataboutcost in the primarysector?

  16. CEA of preventingHAPUs in hospitals: It is not costeffective to prevent 50% of the HAPUs

  17. Uncertaintyanalysis: 1478 -/+25%

  18. Is it a good business for society to preventHAPUs? • Conclusion: From a societal point of view, it is not a good business, the loss from preventingeach HAPU in hospitals is 1478 DKK. • However, the estimate is basedon a 50 % reduction of HAPUs. If the reduction is 64 %, the intervention breaks even. This is verylikely, sincethere has beengoodresultson interventions abroad.

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