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Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis
Cynthia Iglesias1, Jane Nixon, Gillian Cranny
1Department of Health Sciences, University of York, York YO10 5DD.
Insights
Alternating pressure mattresses are more cost-effective for preventing hospital-acquired pressure ulcers than overlays. These mattresses offer greater patient benefits and are more likely to be cost-saving.
Area of Science:
- Healthcare economics
- Clinical nursing research
- Medical device efficacy
Background:
- Hospital-acquired pressure ulcers pose a significant clinical and economic burden.
- Effective prevention strategies are crucial for patient outcomes and healthcare resource management.
- Support surfaces play a key role in pressure ulcer prevention protocols.
Purpose of the Study:
- To compare the cost-effectiveness of alternating pressure mattresses versus alternating pressure overlays for preventing pressure ulcers in hospitalized patients.
- To evaluate the economic impact and clinical benefits of different pressure-relieving support surfaces.
Main Methods:
- A multicentre UK-based pragmatic randomised controlled trial (PRESSURE trial) involving 1971 participants across 11 hospitals.
- Cost-effectiveness analysis alongside the trial, utilizing Kaplan-Meier estimates for time to pressure ulcer development and total treatment costs.
- Intention-to-treat analysis to assess outcomes between the two types of support surfaces.
Main Results:
- Alternating pressure mattresses demonstrated lower average costs (283.63 pounds sterling per patient) primarily due to reduced hospital length of stay.
- A delay in pressure ulcer development was observed with mattresses (10.64 days), though not statistically significant.
- Cost-effectiveness acceptability curves indicated an 80% probability that mattresses are more cost-saving than overlays.
Conclusions:
- Alternating pressure mattresses are likely more cost-effective for preventing pressure ulcers in hospitalized patients compared to alternating pressure overlays.
- The findings suggest mattresses offer better value and patient acceptability, supporting their use in clinical practice.
- Further economic evaluations can inform procurement decisions for pressure-relieving support surfaces.
Objective:
To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital.
Design:
Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial.
Setting:
11 hospitals in six UK NHS trusts.
Participants:
Intention to treat population comprising 1971 participants.
Main Outcome Measures:
Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital.
Results:
Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving.
Conclusion:
Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.
