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  • The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial

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    Author(s)
    Whitty, Jennifer A
    McInnes, Elizabeth
    Bucknall, Tracey
    Webster, Joan
    Gillespie, Brigid M
    Banks, Merrilyn
    Thalib, Lukman
    Wallis, Marianne
    Cumsille, Jose
    Roberts, Shelley
    Chaboyer, Wendy
    Griffith University Author(s)
    Webster, Joan
    Wallis, Marianne
    Chaboyer, Wendy
    Gillespie, Brigid M.
    Whitty, Jennifer A.
    Roberts, Shelley J.
    Bucknall, Tracey
    Thalib, Lukman
    Year published
    2017
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    Abstract
    Background: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. Objectives: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Design: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Settings: Eight tertiary hospitals in Australia. Participants: Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n = 799) or standard care (n = 799). Methods: Direct costs ...
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    Background: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. Objectives: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Design: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Settings: Eight tertiary hospitals in Australia. Participants: Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n = 799) or standard care (n = 799). Methods: Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n = 317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28 days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The costbenefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). Results: The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be −$2320 (95%CI −$3900, −$1175) per patient, suggesting the care bundle was not a cost-effective use of resources. Conclusions: A pressure ulcer prevention care bundle consisting of multicomponent nurse training and patient
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    Journal Title
    International Journal of Nursing Studies
    Volume
    75
    DOI
    https://doi.org/10.1016/j.ijnurstu.2017.06.014
    Copyright Statement
    © 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
    Subject
    Nursing
    Nursing not elsewhere classified
    Publication URI
    http://hdl.handle.net/10072/348640
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    • Journal articles

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