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.
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
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
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
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
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