25HSR ARE ALL PRESSURE ULCERS THE SAME: A TALE OF TWO ORIGINS?

Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Luciano Ieraci, MSc1, Ba' Pham, MSc, PhD, (c)2, Murray D. Krahn, MD, MSc1 and Anita Stern, PhD1, (1)University of Toronto, Toronto, ON, Canada, (2)Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada

Purpose: Pressure ulcers (PUs) are the third costliest disorder after cancer and cardiovascular disease. However the resources utilized for their prevention and treatment are not well understood. Direct costs attributable to PU care were examined in two groups of hospitalized patients: 1) those with PUs acquired while in hospital, and 2) those with PUs present on admission to hospital.

Method: A case-control design was used to obtain stage-specific PU-attributable costs. Direct costs to the hospital included ward care costs, pharmacy costs and overhead costs, and were obtained from the Ontario Case Costing Initiative (OCCI) using a financial model to distribute patient-care costs incurred by the facility to each of its inpatient admissions. The PU-attributable portion was estimated as the difference in direct costs between cases and controls. Group 1 cases were identified with post-admission ICD-10-CA codes for PU. Group 2 cases were identified with admission ICD-10-CA codes for PUs. Controls were matched to cases by 5-year age groups, gender, most responsible diagnosis, and Charlson co-morbidity index. Regression analyses were conducted separately for Groups 1 and 2 using matched data. Estimates of attributable costs were obtained from the fitted multiple linear regression that correlated log-transformed costs with the matched variables (Group 1: R2=0.86; Group 2: R2=0.86). As the detection and recording of stage 1 pressure ulcers in OCCI data may be problematic, only costs attributable to stages 2-4 were obtained.

Result: Total PU costs (with 95% CI) for Group 1 were $19,582 ($13,795, $27,797) for stage 2; $20,390 ($10,235, $40,621) for stage 3; and $29,202 ($14,080, $60,565) for stage 4. For Group 2 the costs were $11,200 ($8,111, $15,464); $9,891 ($5,286, $18,508); and $9,674 ($6,107, $15,323), respectively. PU attributable costs for Group 1 were $12,104 ($6,908, $19,676) for stage 2; $12,912 ($3,349, $32,500) for stage 3; and $21,724 ($7,194, $52,444) for stage 4. The corresponding estimates for Group 2 were $3,237 ($703, $6,905); $1,928 ($0, $9,949); and $1,711 ($0, $6,764), respectively.

Conclusion: Costs associated with PUs acquired in hospital are relatively larger than the costs associated with PUs present on admission. Hospital-acquired PUs seem to be managed relatively more aggressively. Having consistency in resources used for the management of PUs across care settings would be ideal.

Candidate for the Lee B. Lusted Student Prize Competition