VIEWS: 10 PAGES: 19 POSTED ON: 7/10/2014
Cost effectiveness analysis of an intervention to prevent pressure ulcers MPH Health economics Spring 2012 Methodology • Method: ▫ Model: Decision tree, comparison with no intervention ▫ Uncertainty analysis (model/data) • Input data: Based on observation (litterature)+interview • Measure of effectiveness: No of reduced pressure ulcers, No of prevented deaths • Costs: Direct cost • Perspective: Societal perspective: Both hospital and home care costs are included. Epidemiology • It is estimated that 13-43 % of inpatients in Danish hospitals have a pressure ulcer • 7-7,3% of these are estimated to be acquired during hospitalization • Most pressure ulcers are preventable if appropriate measures are taken. Patophysiology • HAPU occurs typically under immobilisation • Pressure on the skin makes an ischaemia, which ultimately can develop an ulcer • Pressure ulcers are graded into 4 stages, where 4 is most severe. Guidelines to prevent pressure ulcers • To prevent hospital acquired pressure ulcers (HAPU), Dansk Selskab for Patientsikkerhed has developed a set of guidelines: ▫ Risk screening of all new patients (Braden/Norton Scale) except for women giving birth. ▫ Patients at risk are daily assessed for HAPU ▫ Patients at risk are nutrition screened ▫ Patients at risk are repositioned frequently and get support surfaces • Target is to reduce HAPUs with 50 % Actions to prevent HAPU in a Danish surgical department • Hand-out of patient information: all patients, once per hospitalisation • Journal writing: all patients, once a day • Risk screening: all patients, once a day • Repositioning: at-risk patients, every second day • Notes in EPJ: at-risk patients, every second day Why conduct a CEA study? • Prevention of HAPUs take additional time for nurses on the hospitals and in homecare – it is therefore not evident, that it is a good business to introduce prevention. New intervention more costly New PREVENTION New intervention less OF HAPUs intervention effective below the more effective maximum acceptable ICER? New intervention less costly Model: Descision tree Death HAPU grade III P=0,35 -IV HAPU P=0,15 No death P=0,035 HAPU grade I- P=0,35 Intervention II No HAPU P=0,85 P=0,965 Death Hospitalization HAPU grade III P=0,35 -IV HAPU P=0,15 No death P=0,07 HAPU grade I- P=0,65 Standard II treatment No HAPU P=0,85 P=0,93 Cost assessed in the hospital and in the primary sector • A health sector (primary and secondary) perspective is chosen • Cost in hospital: ▫ Added nurse time spent on documentation, information and repositioning of patients ▫ Special matresses, sheets, pillows, chairs ▫ Education of nurses • Cost in primary health care ▫ Home care nurses home visits Calculation of prevention costs per patient (average LOS) Activity Share of Time Wage/hr Frequenc Cost, patients DKK y/hospita DKK lisation Hand-out 100 0.0833 277,3 1 23,1 of informatio n Journal 100 0.0167 277,3 4 18,4 writing Screening 100 - 277,3 4 0 Notes in EPJ 40 0.0333 277,3 2 7,4 Repositionin 40 0.833 3 277,3 2 184,9 g, time pr 24h TOTAL 233,9 Calculation of implementation costs pr. stay per patient Impleme Share pr. Time Addi- Discounti Cost DKK ntation patient tional ng, years per measure price/uni patient t DKK per average stay (4 days) Education 0.10 7.5 hrs+7.5 277,3 0.33 1,50 of nurses hrs (substitute) Mattresses, 0.4 - 650 0.25 2,22 pillows, chairs etc TOTAL 3,72 Total cost, prevention of HAPU at hospital Preventive measure Cost DKK Implementation measures 3,72 (mattresses, pillows, chairs etc) Cost of staff pr. intervention 233,9 TOTAL 236,1 Direct cost of HAPU on hospitals Grade Distri Hospit Frequ Cost bution al ency HAPU I-II 85% 15 min Every 138,7 care pr. second patient day HAPU III-IV 15% 20 min Daily 332,8 care pr. patient Weigth 167,8 ed cost of HAPUs Is it a good business for hospitals to prevent HAPUs? • 50 % reduction => from 7 % to 3,5% of all patients • No of inpatients in DK hospitals minus obstetric patients: 1.203.746 (2010) • No of HAPUs prevented: 3,5 % eq. to 42.131 per year • No of deaths prevented: Mortality rate*50%: 2.211 per year • Cost of intervention x inpatient/year= 284.206.606 DKK • Gain for HAPUs saved x 3,5% of patients = 7.068.445 DKK • Conclusion: No, it is not a good business: More expensive for hospitals to prevent HAPUs than to leave the patients with standard treatment. What about cost in the primary sector? Grade Weighte Home Transp Freque Cost, DKK d care ortatio ncy healing n time HAPU I-II 48 days 15 min 20 min Every care pr. second patient day 2.667,29 HAPU III-IV 20 days 20 min 20 min Daily care pr. patient 2.432,52 Weigthed 5.099,81 cost of HAPUs CEA of preventing HAPUs in hospitals: It is not cost effective to prevent 50% of the HAPUs Cost of Gain of Gain of Total cost prevention, prevention, prevention, hospitals, DKK hospitals Primary sector In total -284.206.606 7.068.445 214.860.496 62.277.664 1478 pr. HAPU Uncertainty analysis: 1478 -/+25% Unit Confidential Interval Break-even (per HAPU prevented) Time spent 1124; 1832 Salary 1161; 1796 Healing days 2753; 203 HAPUs 3726; 129 (64 % prevented prevented instead of 50%: +28%) Is it a good business for society to prevent HAPUs? • Conclusion: From a societal point of view, it is not a good business, the loss from preventing each HAPU in hospitals is 1478 DKK. • However, the estimate is based on a 50 % reduction of HAPUs. If the reduction is 64 %, the intervention breaks even. This is very likely, since there has been good results on interventions abroad.
Pages to are hidden for
"Cost effectiveness analysis of an intervention to prevent "Please download to view full document