BUDGET AND HEALTH IMPACT OF STRATEGIES FOR PREVENTING PRESSURE ULCERS IN LONG-TERM CARE FACILITIES IN ONTARIO

Purpose: Pressure Ulcers (PUs) constitute a major health and economic burden for healthcare systems financing Long-Term Care (LTC) facilities worldwide.  We estimated the health and economic impact of standard care and full implementation of strategies for preventing PUs in LTC facilities in Ontario.

Methods: Targeted population for analysis was adult residents (65+) from provincial-administered LTC facilities of Ontario at any risk of developing PUs.  Interventions considered for analysis were (in comparison to standard care): alternate foam (AF) mattresses with and without 4-hourly resident-turning/repositioning schedules, nutritional support, incremental registered nurse (RN) time to resident care, and skin care protocols for urinary/fecal incontinence.  A prevalence-based model was applied in all calculations. The time horizon was from 2008-2012 (2008 was used as base-case).  The analytical perspective was from the Ontario Ministry of Health.  Annual outputs from a decision-tree model served as inputs for the budget and health impact analyses: PU occurrence rate (from stage 1-4), death rate related to PU, PU-free resident rate, Quality-Adjusted Life Years (QALYs), and per-resident costs (i.e., total costs, PU-related, and PU-strategy implementation costs).  Per-patient outcomes of each strategy were multiplied by the estimated number of LTC residents in each given year to generate health and budget impacts.  All costs were reported in 2008 Canadian Dollars.

Results: In 2008, the estimated number of LTC residents in Ontario was 90,166 and total expenditures of $4.4B.  RN time increase produced highest impact in PU prevention (10,163 cases prevented), followed by AF foam mattress plus turning schedule (7,854), AF mattress alone (5,591), skin care protocols (3,077), and nutrition supplement (964), respectively.  Similar patterns were found for prevention of PU-related deaths and number of PU-free residents in 2008.  AF mattresses had the lowest implementation cost in 2008 ($21.1M), followed by nutritional supplementation ($37.8M), skin care protocols ($113.4M), AF mattress plus turning schedules ($149.7M), and RN time increase ($197.9M).  Net budget savings was highest for RN time ($138.8M), followed by AF mattress plus turning schedules ($102.2M), AF mattress alone ($80.4M), skin care protocols ($46.8M), and nutritional supplementation ($15.8M).

Conclusions:  All PU-prevention strategies reduced costs and improved health outcomes of LTC residents in comparison to standard care.  AF mattresses were considered most affordable and with intermediate health impact.  Greatest impacts were from RN time increase, however with substantial implementation cost.