Marsden Grace, Jones Katie, Neilson Julie, Avital Liz, Collier Mark, Stansby Gerard
Office of Health Economics, London, UK.
Royal College of Physicians, London, UK.
J Adv Nurs. 2015 Dec;71(12):2879-85. doi: 10.1111/jan.12753. Epub 2015 Aug 27.
To assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention.
Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis was conducted to identify the most cost-effective repositioning strategy for the prevention of pressure ulcers.
The economic analysis took the form of a cost-utility model.
The clinical inputs to the model were taken from a systematic review of clinical data. The population in the model was older people in a nursing home. The economic model was developed with members of the guideline development group and included costs borne by the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years.
Despite being marginally more clinically effective, alternating 2 and 4 hourly repositioning is not a cost-effective use of UK National Health Service resources (compared with 4 hourly repositioning) for this high risk group of patients at a cost-effectiveness threshold of £20,000 per quality adjusted life years. These results were used to inform the clinical guideline recommendations for those who are at high risk of developing pressure ulcers.
评估两种重新定位策略的成本效益，并为2014年英国国家卫生与临床优化研究所关于压疮预防的临床指南建议提供依据。
压疮是令人痛苦的情况，当皮肤及皮下组织受到足以损害血液供应的压力时就会引发。它们会对生活质量产生重大影响，并带来巨大的资源问题。重新定位是一项关键的预防策略，但可能耗费资源，导致实践中的差异。进行这项经济分析是为了确定预防压疮最具成本效益的重新定位策略。
经济分析采用成本效用模型的形式。
模型的临床输入数据来自对临床数据的系统评价。模型中的人群为养老院中的老年人。经济模型由指南制定小组的成员共同开发，纳入了英国国家医疗服务体系承担的成本。结果以成本和质量调整生命年表示。
对于每质量调整生命年成本效益阈值为20,000英镑的这类高风险患者群体，尽管每2小时和4小时交替重新定位在临床效果上略好，但并非英国国家医疗服务体系资源的成本效益使用方式（与每4小时重新定位相比）。这些结果被用于为有发生压疮高风险人群的临床指南建议提供依据。
