Economic evaluation. Cost-effectiveness of nutritional intervention on healing of pressure ulcers.
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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 ulcers

Cost-effectiveness of nutritional intervention on healing of pressure ulcers

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  • 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.

Economic evaluation. Cost-effectiveness of nutritional intervention on healing of pressure ulcers. Economic evaluation. Cost-effectiveness of nutritional intervention on healing of pressure ulcers. Presentation Transcript

  • Cost-effectiveness ofnutritional intervention onhealing of pressure ulcers Akinori Hisashige Institute of Healthcare Technology Assessment, Japan Takehiko Ohura Pressure Ulcers and Wound Healing Research Center, Japan 1
  • Pressure ulcer(stage III, medium size) 2
  • Pressure ulcer(stage IV, large size) 3
  • Burden 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 hospitals2.2 ~ 3.3%    Long-term care 2.5%    Nursing care 8.3% 4
  • Economic burden of Pressure Ulcers Annual costs for treatment of pressure ulcers UK £ 750 million US $ 3 billion Australia A$ 285 million      5
  • 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 6
  • Methods 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 7
  • Subjects 8
  • Nutritional intervention Mean daily calorie per person Intervention Control t pDuring observation (12w) 1,384 (166) 1,092 (162) 6.226 .0000Follow-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
  • Effectiveness 10
  • Prevalence of pressure ulcers Pressure Ulcer Days 11
  • 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) 12
  • Health 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 Bed-riddenHospital confinement 0.33Mechanical aids to walk and learning disabled 0.31 Bed-riddenDead (reference state) 0 + pressure ulcerConfined to bed with severe pain -Unconscious - 13
  • Incremental effectiveness of nutritional intervention per personEffectiveness 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) 14
  • Costs 15
  • Mean costs per patientItem Intervention ControlNutritional 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 66Total cost per patient 3,718 4,602( 95%CI ) (3,006 ~ 4,340) (4,117 ~ 5,008) 16
  • Incremental cost of nutritional intervention per person Intervention Control Incremental costs (95% CI)Costs $ 3,718 4,603 -881 (-1,285 ~ -478) 17
  • Cost-Effectiveness of Nutritional Intervention 18
  • Incremental cost-effectiveness of nutritional intervention Incremental cost-effectiveness ratio (95% CI) Cost ($) per PUD decreased   -11 (-816 ~ 559) Cost ($) per QALY gained -38,726 (-2926,499 ~ 3096,049) 19
  • Sensitivity Analysis 20
  • Stochastic sensitivity analysis 21
  • Qualitative sensitivity analysis 22
  • Cost-effectivene ss of prevention and treatment Russell, Health Aff, 28, 2009 QALY = quality-adjusted life-year 23
  • 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
  • Stochastic sensitivity analysis 25