Cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario

Pressure ulcers (PUs), commonly known as bedsores, are lesions caused by many factors such as unrelieved pressure over bony prominences, friction, humidity, and shearing forces to any part of the body. PUs are common among residents of long-term care (LTC) homes in Ontario.

Although treatable if found early, PUs can become life-threatening, and in rare instances, lead to fatal infections. PUs impose a significant health and economic burden, costing the Canadian health care system approximately $2.1 billion annually.

The clinical evidence and cost-effectiveness data suggests that some of the prevention strategies considered above lead to substantial improvement in health compared to standard care in LTC homes across Ontario. The prevention strategies with AF mattresses with or without 4-hourly turning/repositioning were somewhat attractive, and were supported by moderate to high quality evidence. These two strategies are economically attractive at an incremental cost-effectiveness ratio (ICER) below $50,000 per QALY gained. In addition, they were associated with lower implementation costs compared to other alternatives. Nutritional supplementation, skin care protocol, and RN time increase strategies cannot be considered cost-effective under the conventional threshold of $50,000 per QALY.

The clinical and economic evidence supports implementation of AF mattresses in LTC homes in Ontario. Reducing the frequency of turning to 4 hourly intervals, in conjunction with implementation of AF mattresses also appears to be economically attractive, but significant uncertainty remains regarding the clinical equivalence of 2-hourly and 4-hourly turning in high risk groups. However, because of the potential for very significant impacts on labor requirements for long-term care facilities (i.e., potential cost savings, or potential allocation of work-time to other effective interventions), this strategy should be evaluated in future research studies.