Purpose: In October of 2008 Medicare ceased to cover the cost associated with hospital-acquired pressure ulcers (PUs), thus placing stress on hospitals to reduce incidence of this costly acute condition. Our objective is to develop a Markov model to evaluate whether prevention methods are cost-effective compared to the approach of standard treatment following PU incidence (‘do-nothing’) in the management of hospital-acquired pressure ulcers.
Method: We developed a Markov model in TreeAge that portrayed the process flow of patients through a hospital from the time of admission through one year using the societal perspective. The model contained health states that could potentially lead to a PU through either the practice of ‘prevention’ for PUs or the ‘do-nothing’ approach. Probabilities, health utility scores, and costs were included in the model based on findings from literature. Costs and effects were discounted at 3%. Univariate and multivariate sensitivity analyses were conducted using 10,000 Monte Carlo simulations.
Result: Based on a willingness-to-pay (WTP) threshold of $0, prevention dominated the do-nothing approach. The expected cost of prevention was $7,122.87, and the expected effectiveness was 11.285 QALYs. The expected cost for do-nothing was $8,155.69, and the expected effectiveness was 9.292 QALYs. These costs and effects are per person in the study population. The results of the probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.98% of the simulations. The threshold where the cost of prevention was no longer dominant was $331.10 per day per person, whereas the estimated cost of prevention in this model was $44.37 per day per person.
Conclusion: The results of this cost-effectiveness analysis suggest that prevention methods are the optimal form of managing hospital patients to avoid the development of a PU. Continuous preventive care of PUs could potentially reduce incidence and prevalence of the acute condition, as well as lead to lower expenditures for hospitals. Considering the large gap between the daily costs for prevention estimated in this model and the cost-threshold where prevention no longer dominates, hospitals may consider increasing investment in prevention strategies to reduce the incidence of PUs.
Candidate for the Lee B. Lusted Student Prize Competition