Cost-effectiveness of a pressure ulcer quality collaborative

Area of Science:

• Healthcare Quality Improvement
• Geriatric Care
• Public Health

Background:

• A Dutch quality improvement collaborative (QIC) implemented evidence-based pressure ulcer (PU) prevention methods across nursing homes, assisted living, and home care.
• The collaborative involved a central expert team and 25 organizational project teams to reduce PU incidence and prevalence.
• The study aimed to evaluate the cost-effectiveness of this QIC from a healthcare perspective.

Purpose of the Study:

• To determine the cost-effectiveness of a quality improvement collaborative (QIC) focused on pressure ulcer (PU) prevention in long-term care.
• To assess the impact of the QIC on PU incidence, prevalence, and patient quality of life.
• To analyze the healthcare costs associated with the QIC interventions.

Main Methods:

• A non-controlled pre-post design was used to track changes in PU incidence and prevalence in 88 patients over one year.
• Data on staff activities, materials, and PU states were collected, with Quality of Life (QoL) weights assigned.
• A Markov model, incorporating effectiveness and cost data, was developed with a probabilistic sensitivity analysis and three sustainability scenarios.

Main Results:

• Pressure ulcer incidence decreased from 15% to 4.5%, and prevalence dropped from 38.6% to 22.7% among the 88 patients.
• Average patient Quality of Life (QoL) increased by 0.02 Quality Adjusted Life Years (QALYs) over two years.
• Healthcare costs rose by approximately €2000 per patient, with an Incremental Cost-effectiveness Ratio (ICER) ranging from €78,500 to €131,000.

Conclusions:

• The QIC led to significant reductions in PU incidence and prevalence.
• In the short term, the QIC was more costly and effective than standard care, but long-term cost-effectiveness remains uncertain.
• Sustained improvements in PU incidence and prevalence are crucial for the QIC to be considered cost-effective in the long run.