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Arch Phys Med Rehabil. 2011 Jun;92(6):866-72. doi: 10.1016/j.apmr.2010.12.038.

Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury.

Author information

1
Health Outcomes and PharmacoEconomics Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. nicole.mittmann@sunnybrook.ca

Abstract

OBJECTIVE:

To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective.

DESIGN:

A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted.

SETTING:

The perspective of this analysis is from a Canadian public health system payer.

PARTICIPANTS:

Model target population was an SCI cohort with grade III/IV PUs.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURE:

Incremental cost per PU healed.

RESULTS:

ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC.

CONCLUSIONS:

The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population.

PMID:
21621661
DOI:
10.1016/j.apmr.2010.12.038
[Indexed for MEDLINE]

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