Economic Evaluation of Multilayer Silicone-Adhesive Polyurethane Foam Dressing for the Prevention of Pressure Ulcers in At-Risk Hospitalized Patients: US and Italian Perspective

Articles in Press

Document Type : Original Article

Authors

1 Department of Diagnostics and Public Health, University of Verona, Verona, Italy

2 Smith and Nephew, Fort Worth, TX, USA

3 Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK

4 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

Abstract

Background 
Hospital-acquired pressure ulcers (HAPUs) constitute an important source of concern for healthcare systems due to their negative consequences on patient quality of life and hospital costs. This phenomenon is increasing worldwide, driven by an aging population and increasing prevalence of chronic conditions. This economic evaluation aimed to determine whether using a multilayer, silicone-adhesive polyurethane foam dressing shaped for the sacrum area, alongside standard prevention (SP), is cost-effective in preventing HAPUs for hospitalized patients compared to SP alone.
 
Methods 
We developed a decision-analytic model to estimate the expected costs and clinical benefits of using the polyurethane foam dressing from Italian and US payor perspectives. Model inputs were taken from published studies, and uncertainty was assessed using one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA).
 
Results 
From both US and Italian perspectives, using a foam dressing in addition to SP was found to be cost-saving in all hospital settings. That is, it reduced the incidence of HAPUs at a lower cost overall. The estimated savings were €179 per patient and $305 per patient from Italian and US perspectives. Following sensitivity analysis, the results remained cost-saving, suggesting that our findings are robust.
 
Conclusion 
This is the first economic analysis investigating the cost-effectiveness of preventive dressings and SP for avoiding sacral pressure ulcers for at-risk hospitalized patients. This analysis suggests that using a multilayer polyurethane foam dressing to prevent sacral HAPUs in at-risk hospitalized patients is a cost-effective strategy compared with SP alone and, therefore, should be considered as a strategy for PU prevention in hospital settings. 

Keywords

References

  1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. In: Haesler E, ed. The International Guideline. EPUAP, NPIAP, PPPIA; 2019.
  2. Moore Z, Patton D, Avsar P, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care. 2020;29(6):312-320. doi:12968/jowc.2020.29.6.312
  3. Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2019;1(1):CD006471. doi:1002/14651858.CD006471.pub4
  4. Zhang X, Zhu N, Li Z, Xie X, Liu T, Ouyang G. The global burden of decubitus ulcers from 1990 to 2019. Sci Rep. 2021;11(1):21750. doi:1038/s41598-021-01188-4
  5. Roussou E, Fasoi G, Stavropoulou A, et al. Quality of life of patients with pressure ulcers: a systematic review. Med Pharm Rep. 2023;96(2):123-130. doi:15386/mpr-2531
  6. Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019;16(3):634-640. doi:1111/iwj.13071
  7. Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J. 2020;17(6):1924-1934. doi:1111/iwj.13482
  8. Guest JF, Fuller GW, Vowden P, Vowden KR. Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes. BMJ Open. 2018;8(7):e021769. doi:1136/bmjopen-2018-021769
  9. Forni C, Searle R. A multilayer polyurethane foam dressing for pressure ulcer prevention in older hip fracture patients: an economic evaluation. J Wound Care. 2020;29(2):120-127. doi:12968/jowc.2020.29.2.120
  10. Demarré L, Van Lancker A, Van Hecke A, et al. The cost of prevention and treatment of pressure ulcers: a systematic review. Int J Nurs Stud. 2015;52(11):1754-1774. doi:1016/j.ijnurstu.2015.06.006
  11. Forni C, D'Alessandro F, Gallerani P, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: a pragmatic randomised controlled trial. Int Wound J. 2018;15(3):383-390. doi:1111/iwj.12875
  12. Chiari P, Forni C, Guberti M, Gazineo D, Ronzoni S, D'Alessandro F. Predictive factors for pressure ulcers in an older adult population hospitalized for hip fractures: a prognostic cohort study. PLoS One. 2017;12(1):e0169909. doi:1371/journal.pone.0169909
  13. Santamaria N, Gerdtz M, Sage S, et al. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J. 2015;12(3):302-308. doi:1111/iwj.12101
  14. Forni C, Gazineo D, Allegrini E, et al. Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: randomized controlled trial. Int J Nurs Stud. 2022;127:104172. doi:1016/j.ijnurstu.2022.104172
  15. Hahnel E, El Genedy M, Tomova-Simitchieva T, et al. The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial. Br J Dermatol. 2020;183(2):256-264. doi:1111/bjd.18621
  16. Beeckman D, Fourie A, Raepsaet C, et al. Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial. Br J Dermatol. 2021;185(1):52-61. doi:1111/bjd.19689
  17. Posnett J, Gottrup F, Lundgren H, Saal G. The resource impact of wounds on health-care providers in Europe. J Wound Care. 2009;18(4):154-161. doi:12968/jowc.2009.18.4.41607
  18. ISTAT Database. Available at: http://dati.istat.it/. Accessed June 14, 2023.
  19. S. Bureau of Labor Statistics. https://data.bls.gov/timeseries/CUUR0000SAM. Accessed June 14, 2023.
  20. Zurynski Y, Herkes-Deane J, Holt J, et al. How can the healthcare system deliver sustainable performance? A scoping review. BMJ Open. 2022;12(5):e059207. doi:1136/bmjopen-2021-059207
  21. Coiera E, Hovenga EJ. Building a sustainable health system. Yearb Med Inform. 2007;16(1):11-18.
  22. El Genedy M, Hahnel E, Tomova-Simitchieva T, et al. Cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in high-risk intensive care unit patients: An economic analysis of a randomised controlled trial. Int Wound J. 2020;17(5):1291-1299. doi:1111/iwj.13390
  23. Oe M, Sasaki S, Shimura T, Takaki Y, Sanada H. Effects of multilayer silicone foam dressings for the prevention of pressure ulcers in high-risk patients: a randomized clinical trial. Adv Wound Care (New Rochelle). 2020;9(12):649-656. doi:1089/wound.2019.1002
  24. Rahman-Synthia SS, Kumar S, Boparai S, Gupta S, Mohtashim A, Ali D. Prophylactic use of silicone dressing to minimize pressure injuries: systematic review and meta-analysis. Enferm Clin (Engl Ed). 2023;33(1):4-13. doi:1016/j.enfcle.2022.05.002
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 10 November 2024

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History

  • Receive Date: 05 December 2023
  • Revise Date: 25 October 2024
  • Accept Date: 09 November 2024
  • First Publish Date: 10 November 2024

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