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Int Wound J. 2019 Sep 2. doi: 10.1111/iwj.13174. [Epub ahead of print]

Five-layer border dressings as part of a quality improvement bundle to prevent pressure injuries in US skilled nursing facilities and Australian nursing homes: A cost-effectiveness analysis.

Author information

1
Department of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, California.
2
The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California.
3
Department of Economics, University of Virginia, Charlottesville, Virginia.
4
Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

The BORDER III trial found that five-layer silicone border dressings effectively prevented pressure injuries in long-term care, but the value of this approach is unknown. Our objective was to analyse the cost-effectiveness of preventing facility-acquired pressure injuries with a quality improvement bundle, including prophylactic five-layer dressings in US and Australian long-term care. Markov models analysed the cost utility for pressure injuries acquired during long-term care from US and Australian perspectives. Models calibrated outcomes for standard care compared with a dressing-inclusive bundle over 18 monthly cycles or until death based on BORDER III outcomes. Patients who developed a pressure injury simulated advancement through stages 1 to 4. Univariate and multivariate probabilistic sensitivity analyses tested modelling uncertainty. Costs in 2017 USD and quality-adjusted life years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). Dressing use yielded greater QALYs at slightly higher costs from perspectives. The US ICER was $36 652/QALY, while the Australian ICER was $15 898/QALY, both of which fell below a willingness-to-pay threshold of $100 000/QALY. Probabilistic sensitivity analysis favoured dressings as cost-effective for most simulations. A quality improvement bundle, including prophylactic five-layer dressings, is a cost-effective approach for pressure injury prevention in all US and Australia long-term care residents.

KEYWORDS:

long-term care; nursing home; pressure injury; pressure ulcer; prophylactic dressing; skilled nursing facility

PMID:
31475434
DOI:
10.1111/iwj.13174

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