economic evaluation. cost-effectiveness of nutritional intervention on healing of pressure ulcers
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Cost-effectiveness of nutritional intervention on healing of pressure ulcersTRANSCRIPT
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Cost-effectiveness of Cost-effectiveness of nutritional intervention on nutritional intervention on healing of pressure ulcershealing of pressure ulcers
Akinori HisashigeInstitute of Healthcare Technology
Assessment, Japan
Takehiko OhuraPressure Ulcers and Wound Healing
Research Center, Japan
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Pressure ulcer Pressure ulcer (stage III, medium size)(stage III, medium size)
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Pressure ulcerPressure ulcer (stage IV, large size) (stage IV, large size)
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Burden of Pressure UlcersBurden of Pressure Ulcers
Prevalence rateUS, UK, Can Hospitals 4.7 ~ 32.1% Nursing homes 4.6 ~ 20.7% Community care 4.4 ~ 33.0%Japan General hospitals 2.2 ~ 3.3% Long-term care 2.5% Nursing care 8.3%
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Economic burden of Pressure UlcersEconomic burden of Pressure Ulcers
Annual costs for treatment of pressure ulcers
UK £ 750 millionUS $ 3 billionAustraliaA$ 285 million
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Evidence for Nutritional Interventions Evidence for Nutritional Interventions on Pressure Ulcerson Pressure Ulcers
JAMA, 2006, 2008JAMA, 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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MethodsMethods Design: cost-effectiveness analysis Perspective: societal ( hospital)≒ Clinical evidence: RCT Intervention: nutritional supplementation (targeted
energy goal) Duration: 16 weeks (12-week observation + 4-week
follow-up) Effectiveness: PUDs, QALYs Costs: direct costs (indirect costs, not included) Economic measure: Cost per QALY gained
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SubjectsSubjects
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Nutritional interventionNutritional interventionMean daily calorie per personMean 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)
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EffectivenessEffectiveness
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Prevalence of pressure ulcers
Pressure Ulcer Days
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Utility value for pressure ulcersUtility 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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Health state utilitiesHealth state utilitiesHealthy (reference state) 1.00Menopausal symptoms 0.99Side effects of hypertension treatment 0.95Mild angina 0.90Kidney transplant 0.84Moderate angina 0.70Hospital dialysis 0.56Severe angina 0.50Anxious/depressed and lonely much of the time 0.45Being blind or deaf or dumb 0.39 Hospital confinement 0.33Mechanical aids to walk and learning disabled 0.31Dead (reference state) 0
Confined to bed with severe pain -Unconscious -
Bed-ridden
Bed-ridden +
pressure ulcer
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Incremental effectiveness of Incremental effectiveness of nutritional intervention per personnutritional intervention per person
Effectiveness Intervention Control Incremental effectiveness (95% CI)
PUDs84.6 100.8 -16.2 (-8.7 ~ -23.7)
QALYs (x10 - 2 )-2.00 -2.38 0.382 (0.205 ~ 0.559)
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CostsCosts
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Mean costs per patientMean costs per patient
Item Intervention Control
Nutritional management Total 905 891 Intervention period 773 695Wages Nurse 1,687 2,335 Physician 277 387 Others 40 545Drugs 99 174Dressing materials 100 138Consumables 45 66Mattress 58 66
Total cost per patient 3,718 4,602( 95%CI ) (3,006 ~ 4,340) (4,117 ~ 5,008)
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Incremental cost of nutritional Incremental cost of nutritional intervention per personintervention per person
Intervention Control Incremental costs (95% CI)
Costs $
3,718 4,603 -881
(-1,285 ~ -478)
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Cost-Effectiveness of Nutritional Cost-Effectiveness of Nutritional InterventionIntervention
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Incremental cost-effectiveness of Incremental cost-effectiveness of nutritional interventionnutritional intervention
Incremental cost-effectiveness ratio (95% CI)
Cost ($) per PUD decreased -11 (-816 ~ 559)
Cost ($) per QALY gained
-38,726 (-2926,499 ~ 3096,049)
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Sensitivity AnalysisSensitivity Analysis
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Stochastic sensitivity analysisStochastic sensitivity analysis
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Qualitative sensitivity analysisQualitative sensitivity analysis
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Cost-effectiveneCost-effectivene ss ss of prevention and treatmentof prevention and treatment Russell, Health Aff, 28, 2009
QALY = quality-adjusted life-year
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ConclusionConclusion
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.
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Stochastic sensitivity analysisStochastic sensitivity analysis