Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis

Ann Emerg Med. 2011 Nov;58(5):468-78.e3. doi: 10.1016/j.annemergmed.2011.04.033. Epub 2011 Aug 5.


Study objective: Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients.

Methods: Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon.

Results: The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was $0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of $32 per patient. If decisionmakers are willing to pay $50,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses ($3,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty.

Conclusion: The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Beds / economics*
  • Cost-Benefit Analysis
  • Emergency Service, Hospital
  • Home Care Services / economics
  • Hospital Costs
  • Humans
  • Markov Chains
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / prevention & control*
  • Quality of Life