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AuthorWhitty, Jennifer A
AuthorMcInnes, Elizabeth
AuthorBucknall, Tracey
AuthorWebster, Joan
AuthorGillespie, Brigid M
AuthorBanks, Merrilyn
AuthorThalib, Lukman
AuthorWallis, Marianne
AuthorCumsille, Jose
AuthorRoberts, Shelley
AuthorChaboyer, Wendy
Available date2017-08-13T09:23:24Z
Publication Date2017-06-01
Publication NameInternational Journal of Nursing Studies
Identifierhttp://dx.doi.org/10.1016/j.ijnurstu.2017.06.014
CitationThe cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial Whitty, Jennifer A. et al. International Journal of Nursing Studies , Volume 75 , 35 - 42
ISSN0020-7489
URIhttp://hdl.handle.net/10576/5616
AbstractPressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Eight tertiary hospitals in Australia. Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient education may promote best practice nursing care but may not be cost-effective in preventing hospital acquired pressure ulcer.
Languageen
PublisherElsevier
SubjectCluster randomised trial
Cost-effectiveness
Economic evaluation
Nursing interventions
Pressure ulcer prevention
TitleThe cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial.
TypeArticle
Pagination35-42
Volume Number75
ESSN1873-491X
dc.accessType Open Access


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