OBJECTIVES: Pressure ulcers (PU) are distressing events, caused when skin and the 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, with extended hospital stays and significant staff time devoted to treating the more severe cases. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis formed part of the National Institute for Health and Care Excellence (NICE) clinical guideline on PU prevention and management, and was conducted to identify the most cost-effect repositioning strategy for the prevention of PU.

METHODS: The clinical inputs to the model were taken from the systematic review of clinical data conducted for the guideline. The model population was elderly people in a nursing home; this represents a group at high risk of developing a PU. The economic model was developed in consultation with members of the guideline development group (GDG), and took the perspective of the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years (QALYs).

RESULTS: Despite being marginally more clinically effective, 2 and 4 hourly repositioning is not cost-effective (compared to 4 hourly repositioning) for this high risk group of patients at a cost-effectiveness threshold of £20,000 per QALY. The ICER was £1,854,070 per QALY.

CONCLUSIONS:

FUNDING: This work was undertaken by the National Clinical Guideline Centre, which received funding from NICE. The views expressed in this publication are those of the authors and not necessarily of the institute.