Resumen de Turning high‐risk individuals: an economic evaluation of repositioning frequency in long‐term care
Petros Pechlivanoglou, Mike Paulden, Ba'- Pham, Josephine Wong, Susan D. Horn, Murray Krahn
Recent evidence suggests that less frequent repositioning of long‐term care residents at moderate to high risk of developing pressure ulcers (PrUs) is noninferior to current repositioning standards in preventing PrUs, but the long‐term health and economic consequences of less frequent repositioning have not been adequately estimated. Our objective was to estimate the cost‐effectiveness of different repositioning strategies (2‐, 3‐, 4‐hour intervals). We conducted a cost‐utility analysis using a lifetime horizon based on data from a randomized clinical trial and the literature. We updated a published PrU decision model with resource usage, unit costs, and epidemiological estimates from the literature and from a small observational study. The Ontario Ministry of Health and Long‐Term Care perspective was taken. We estimated lifetime costs to be CAN$5,425 (95% credible interval (CrI)=$922–12,166) less per resident with 3‐hour repositioning than with 2‐hour repositioning and CAN$3,296 (95% CrI=$483–9,738) less than with 4‐hour repositioning. The gain in expected quality‐adjusted life years from a 3‐ to a 2‐hour repositioning strategy was 0.008, (95% CrI=0.005–0.016) and from a 3‐ to a 4‐hour repositioning strategy was 0.009 (95% CrI=0.007–0.018). Repositioning at 3‐hour intervals was the dominant strategy with respect to the incremental cost‐effectiveness ratio against the 2‐ and 4‐hour strategies. Sensitivity analysis showed a 99% probability that 3‐hour repositioning was a dominant strategy. We concluded that repositioning at 3‐hour intervals for residents at moderate or high risk of PrUs and who were cared for on high‐density foam mattresses appeared to be the most cost‐effective strategy.
