Department of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, California, USA.
Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA.
Int Wound J. 2024 Mar;21(3):e14452. doi: 10.1111/iwj.14452. Epub 2023 Nov 1.
Pressure injury (PrI) prevention guidelines recommend 2-h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost-effectiveness of PrI prevention protocols with 2-, 3- and 4-h repositioning intervals in US nursing homes according to 'Turn Everyone and Move for Ulcer Prevention' (TEAM-UP) randomized controlled trial findings. Markov modelling compared 2-, 3- and 4-h repositioning intervals, controlling for other practice guidelines, to prevent PrIs in nursing home residents from a US health sector perspective over one year using TEAM-UP trial data for model structure, sampling and parameterization. Costs, captured in 2020 US dollars, and quality-adjusted life years (QALYs) were used to derive an incremental cost-effectiveness ratio and net monetary benefit (NMB) at $50 000/QALY-$150 000/QALY cost-effectiveness thresholds. Sensitivity analyses tested model uncertainty. Repositioning intervals between 3 and 4 h were cost-effective based on reduced costs at slightly lower QALYs than 2 h at a $50 000/QALY threshold, and the NMB of 4-h repositioning was also more efficient than at 3 h ($9610). Repositioning labour cost and prevention routines were among the most sensitive parameters. Sensitivity analyses demonstrated that 3- and 4-h intervals were cost-effective in over 65% of simulations at any cost-effectiveness threshold. Repositioning intervals of 3 to 4 h have potential to reduce nursing time costs without significant decrements in clinical benefits to nursing home residents. Clinical guidelines for PrI prevention should be updated to reflect TEAM-UP clinical and economic findings. Facilities can use cost-savings recuperated from nursing time to deploy to other patient safety priorities without seriously jeopardizing PrI safety.
压力性损伤（PrI）预防指南建议在医疗保健环境中每 2 小时进行一次翻身，这需要大量的护理时间投入。根据“全员翻身预防溃疡”（TEAM-UP）随机对照试验结果，我们分析了美国疗养院中 PrI 预防方案在 2 小时、3 小时和 4 小时翻身间隔下的成本效益。Markov 模型根据 TEAM-UP 试验数据，从美国卫生部门的角度，在一年时间内比较了 2 小时、3 小时和 4 小时翻身间隔，控制了其他实践指南，以预防疗养院居民发生 PrI。使用 TEAM-UP 试验数据进行模型结构、抽样和参数化。成本以 2020 年的美元计算，质量调整生命年（QALYs）用于得出增量成本效益比和净货币收益（NMB）在 50000 美元/QALY-150000 美元/QALY 的成本效益阈值。敏感性分析测试了模型的不确定性。在 50000 美元/QALY 的阈值下，与 2 小时相比，3 小时和 4 小时的翻身间隔在降低成本的同时略微降低了 QALYs，具有成本效益，而 4 小时翻身的 NMB 也比 3 小时更有效（9610 美元）。翻身劳动力成本和预防常规是最敏感的参数之一。敏感性分析表明，在任何成本效益阈值下，3 小时和 4 小时的间隔在超过 65%的模拟中具有成本效益。3 至 4 小时的翻身间隔有可能在不显著降低临床效益的情况下降低护理时间成本，从而预防疗养院居民的压力性损伤。PrI 预防临床指南应更新，以反映 TEAM-UP 的临床和经济发现。设施可以使用从护理时间节省的成本来部署到其他患者安全优先事项，而不会严重危及压力性损伤的安全。
