Health economic analyses
Seven economic papers were retrieved.21-27 Five were health economic analyses.22-25,27 One was a commentary on a cost-effectiveness model 21 and another was a review paper on the
importance of the economic modeling in establishing guidelines.26 analysis studies are summarized below.
The five health economic
Iglesias et al.22 assessed the cost-effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of PUs in patients admitted to hospital. This analysis was carried out alongside the pressure relieving support surfaces PRESSURE trial9; 11 hospitals in the UK participated (N=1971).22 The main outcomes were Kaplan Meier estimates of restricted mean time to development of PUs and total costs for treatment in hospital. Alternating pressure mattresses were associated with lower overall costs (£283.6 per patient on average, 95% CI -£377.59 to £976.79). These results were mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average, 95% CI-24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost-effectiveness acceptability curve indicated that on average, alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. The authors concluded that alternating pressure mattresses for the prevention of PUs were more likely to be cost-effective and were more acceptable to patients than alternating pressure overlays. 22
Catz et al.23 evaluated the economic profitability of a new computerized mattress system (Matrix 200) in patients with spinal cord injuries (SCI) and as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention. They compared the new system to two other alternatives: a foam egg carton mattress positioned on a regular foam mattress and the low air loss bed system. In this analysis the cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis. The authors found that a foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositioning, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositioning, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost (costs are not reported here because they are in 1999 New Israeli Shekels - NIS). This economic evaluation indicated that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. 23
Gebhardt et al.27 reported on an approach initiated at a large teaching trust (approximately 1000 beds) which pertained to a pressure area care equipment service. Over 200 mattress overlays and replacements were purchased and a mattress coordinator was appointed to manage the stock, and at night, the nursing service was in charge of supplying the wards. The type of equipment (mattress, overlay and others) that was purchased were evidence-based driven (guided by the interpretation of published clinical trials) and by the hospital internal data on equipment reliability. The project was associated with a reduction in cost and a consistent reduction in PU incidence in areas where the beds were provided. The cost of approximately £157,000 per annum compared favourably with expenditures reported in the past for some other
Specialty Mattresses for Prevention of PUs in Acute and Critical Care