Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Ba' Pham, MSc, PhD, (c)1, Anita Stern, PhD2, Jeff Poss, PhD3, Rosemarie Lourenco, CHIM, IMS4, Luciano Ieraci, MSc2, Nancy Sikich, PhD4, William Witteman, MISt2, Steven Carcone, MSc1 and Murray D. Krahn, MD, MSc2, (1)Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada, (2)University of Toronto, Toronto, ON, Canada, (3)University of Waterloo, Waterloo, ON, Canada, (4)Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
Purpose:
In Ontario, case managers of home care clients can provide pressure-redistribution mattresses (PRM) only for TREATMENT of severe pressure ulcers. We evaluated the cost effectiveness of a strategy to identify and offer PREVENTIVE PRMs to high risk clients. Methods:
Study design: Cost-utility analysis, health ministry perspective, lifetime time horizon, 2009 Canadian $. Subsequently, population-based projections were derived to evaluate related health system implications. Population: long-stay clients of 14 Ontario Community Care Access Centers (251,027 clients/year). Comparators: PRMs for high risk clients (identified via a validated Minimum Data Set - Pressure Ulcer Risk Assessment - MDS-PURS score of 1+ {i.e. ≥ 1}, 2+ or 3+) versus clients on home mattresses (HMs). Effectiveness: Systematic reviews estimated that PRM reduced PU incidence by 60% (RR: 0.40, 95%CI: 0.21, 0.74). Decision model: A weekly-cycle Markov cohort model to simulate 1) care transitions across settings and 2) PU prognosis. The model was calibrated to reflect prevalence and incidence among 77,381 long-stay HC clients. Input data: The mattress cost: $325 - $450. Setting-specific costs were derived using data from MDS-HC (n=21,578 clients), Ontario Case Costing (n=3,780 patients), and the MDS (n=18,321 residents). Health utility: A utility decrement estimate attributable to PU stage 2-4 of 6.1% (3.9%, 8.3%) was derived using data from the MDS – Health Status Index (n=18,321). Mean MDS-HIS utility for HC clients (n=332) was 0.56. Results:
The one-year PU incidence among all clients was 2.25%. It was reduced to 0.99%, 1.52% and 1.85% if AFMs were prescribed to the 70%, 28% and 9% high risk clients according to MDS-PURS 1+, +2, and +3 risk level, respectively. The associated number-needed-to-treat was 79, 137 and 258, respectively. According to the cost-utility analysis, AFMs were associated with an expected QALY gain per home care client of 0.0069, 0.0031 and 0.0012, respectively. The associated cost saving was $34, $31, and $21, respectively. At the population level, the expected cost saving with AFMs was $8.5M, $7.8M and $5.5M, respectively. The respective net cost after AFM implementation cost was $48M, $7.8M and $5.5M. Conclusions:
Offering AFMs to high risk clients was projected to be highly economically attractive, and associated with substantial aggregate cost savings. Offering AFMs only to the highest risk groups may be the most feasible strategy in the current climate of fiscal constraint.
Candidate for the Lee B. Lusted Student Prize Competition
