Cost Effectiveness of an Air-inflated Static Overlay for Pressure Ulcer Prevention: A Randomized, Controlled Trial
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Index: WOUNDS. 2012;24(8):207–214.
Abstract: Numerous pressure-relieving surfaces of varying costs are available for the prevention of pressure ulcers. There is insufficient evidence to draw conclusions regarding the efficacy or merits of using more expensive technologies. The purpose of this unblinded, randomized, prospective study was to compare the clinical and the cost effectiveness of an inflated overlay with rented, pressure-relieving surfaces for the prevention of pressure ulcers. Methods. Patients in a 257-bed acute care facility were included if they had a Braden score of < 14, had no skin lesion(s), were 18 years, weighed <300 lb, and submitted signed consent. One hundred, ten patients (110) were randomized into a control group using either a microfluid static overlay (MSO) or a low-air-loss dynamic mattress (LALDM) with pulsation (n = 55) or into an experimental group using an inflated static overlay (ISO) (n = 55). Both groups had identical positioning protocols. No statistically significant differences were noted between the 2 groups with regard to age, gender, weight, or Braden scale score.
Head-to-toe assessments were performed 3 times a week for a maximum of 14 days to determine presence of pressure ulcers and comfort; Fisher’s exact and chi-squared tests were used to assess categorical data, and unpaired t-test and Mann-Whitney statistic tests were used to compare continuous variables. Comparative cost of support surface use was determined at the end of the study. Results. In the control group, 50 patients used an MSO and 5 patients used an LALDM; in the experimental group, 55 patients used an ISO. No significant difference in pressure ulcer incidence was found between the control (n = 6) and experimental groups (n = 2) (11% versus 4%, respectively; P = 0.2706), and there was no significant difference in comfort (90% versus 85%; P = 0.7129). However, a significant difference was noted in total cost ($13,606 CAD versus $3,364 CAD, P < 0.001); the ISO was less expensive. Conclusion. The use of an ISO offers a cost-effective option for the prevention of pressure ulcers in a moderate to very high-risk population.
Pressure ulcers represent a serious condition that can increase morbidity and mortality, reduce quality of life, and constitute a substantial financial burden for any health care system.1A pressure ulcer is defined as localized damage to the skin and/or underlying tissue, usually over a bony prominence, that results from prolonged pressure on the skin or pressure in combination with shear and/or friction.2
According to Woodbury’s study, pressure ulcer prevalence is estimated at 25.1% for acute care facilities, 29.9% in long-term care, 22.1% for mixed institutions, and 15.1% in home and community care. Average pressure ulcer prevalence for all health institutions is 26%.3 Most pressure ulcers occur in the hospital setting, and 58% to 92% develop within 14 days.4 Many factors are associated with increasing pressure ulcer risk, including intensity and duration of the pressure.5 The incidence of pressure ulcers can be reduced by identifying people at risk of developing a pressure ulcer and by using prevention strategies. Providing patients with a pressure-relieving device is a documented prevention measure.6,7
Evidence that high-tech pressure-relieving mattresses and overlays are more effective than low-tech mattresses and overlays is insufficient.6-8 Due to important costs associated with pressure-relieving surfaces, rigorous research comparing different support surfaces is needed. In 2001, Pompeo used the severity of pressure ulcers to determine that the cost of treatment for wound care varied from $20,000 USD to $55,000 USD per pressure ulcer.