OBJECTIVES : Pressure injuries (PrI) in nursing homes (NH) cause significant morbidity and escalating costs. International guidelines suggest repositioning every 2 to 4 hours to prevent PrI. Our objective was to analyze the cost-effectiveness of 3 PrI prevention repositioning frequencies at 2-, 3- and 4-hour intervals to reflect the value of nursing time spent caring for U.S. NH residents.

METHODS : We analyzed resident repositioning frequency cost-utilities using a Markov model to capture US health sector perspectives over a 1-year horizon in hourly cycles. Parameters were abstracted from published literature and the TEAM-UP clinical trial. Although the TEAMP-UP trial observed zero pressure injuries, our model assumed variability in pressure injury rates based on hourly repositioning regimens to reflect potential real-world outcomes. Costs were measured in U.S. dollars, and effectiveness in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICER) were derived for each comparator at a $100,000/QALY willingness-to-pay threshold. One-way and probabilistic sensitivity analyses (PSA) tested model uncertainty.

RESULTS : Base case estimates demonstrated 4-hours is a cost-effective alternative to 2- and 3-hour repositioning frequencies. Relative to 2-hour repositioning at a cost of $129,947 and 1.97 QALYs per-patient, 3-hour resulted in $116,887 and 1.78 QALYs, and 4-hour resulted in $110,945 and 1.70 QALYs. The ICERs indicated that 3- and 4-hour intervals were cost-effective relative to 2-hours at ICERs of $69,124/QALY and $69,752/QALY respectively. Nursing time cost due to repositioning and hourly prevention were the most sensitive parameters. At lower willingness-to-pay thresholds of $70,000 or less, PSAs demonstrated 4-hour intervals were more cost-effective in most simulations. Above $70,000, 2-hour repositioning protocols were more cost-effective.

CONCLUSIONS : Cost-effectiveness evaluation of 3- and 4-hour repositioning frequencies demonstrates potential for reduced labor costs and shifting of human and financial resources to support other aspects of PrI prevention and long-term nursing tasks, without significant decrements in NH resident outcomes.