Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses

Wound Repair Regen. Nov-Dec 2015;23(6):915-21. doi: 10.1111/wrr.12350. Epub 2015 Oct 7.


The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Nursing Research / economics*
  • Cost-Benefit Analysis
  • Humans
  • Japan / epidemiology
  • Markov Chains
  • Nurse Clinicians* / economics
  • Pressure Ulcer / economics
  • Pressure Ulcer / nursing
  • Pressure Ulcer / physiopathology*
  • Prevalence
  • Quality-Adjusted Life Years
  • Wound Healing*