OBJECTIVES: Pressure injuries (PrI) in nursing homes (NH) cause significant morbidity and escalating costs. Technology advances may offer nurses a reduced time commitment to prevention while maintaining patients’ safety. Our objective was to analyze the cost-effectiveness of 3 PrI prevention protocols with varied repositioning frequencies to reflect the value of nursing time caring for U.S. NH residents.

METHODS: We analyzed repositioning frequency cost-utilities at 2-, 3- and 4-hour intervals to prevent PrIs. A Markov model captured US societal and health sector perspectives over a 1-year time horizon in hourly cycles. Data parameters were abstracted from published literature and the TEAM-UP clinical trial. Model outcomes were driven by nursing time costs associated with prevention protocols. 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: Repositioning frequencies at 3- and 4-hours were associated with lower projected nursing time costs than the 2-hour frequency care standard. Relative to 2-hour repositioning at a cost of $135,500 and 7.59 QALYs per-patient, 3-hour resulted in $123,369 and 6.47 QALYs, and 4-hour resulted in $117,769 and 6.33 QALYs. The ICERs indicated that 3- and 4-hour intervals were cost-effective relative to 2-hours at ICERs of $10,862/QALY and $14,021/QALY respectively. Nursing time cost is the most sensitive parameter in this model. PSAs demonstrated 4-hour intervals were cost-effective in 100% of simulations.

CONCLUSIONS: Repositioning is an accepted PrI prevention strategy with every 2-hour repositioning defined as standard of care. Cost-effectiveness evaluation of 3- and 4-hour repositioning frequencies demonstrates their potential for reduced labor costs and shifting of human and financial resources to support other aspects of PrI prevention.