2010

BACKGROUND: Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritiol support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. OBJECTIVES: To evaluate the cost-effectiveness of nutritiol support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information alysis (VOI). METHODS: The alysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-alysis. Resources were valued using 2014 prices and the time horizon of the alysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. RESULTS: Compared with standard hospital diet, nutritiol support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritiol support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritiol support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. CONCLUSIONS: Nutritiol support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.