Turning High-Risk Individuals: An Economic Evaluation of Repositioning Frequency in Long-Term Care

J Am Geriatr Soc. 2018 Jul;66(7):1409-1414. doi: 10.1111/jgs.15387. Epub 2018 Apr 20.


Recent evidence suggests that less frequent repositioning of long-term care residents at moderate to high risk of developing pressure ulcers (PrUs) is noninferior to current repositioning standards in preventing PrUs, but the long-term health and economic consequences of less frequent repositioning have not been adequately estimated. Our objective was to estimate the cost-effectiveness of different repositioning strategies (2-, 3-, 4-hour intervals). We conducted a cost-utility analysis using a lifetime horizon based on data from a randomized clinical trial and the literature. We updated a published PrU decision model with resource usage, unit costs, and epidemiological estimates from the literature and from a small observational study. The Ontario Ministry of Health and Long-Term Care perspective was taken. We estimated lifetime costs to be CAN$5,425 (95% credible interval (CrI)=$922-12,166) less per resident with 3-hour repositioning than with 2-hour repositioning and CAN$3,296 (95% CrI=$483-9,738) less than with 4-hour repositioning. The gain in expected quality-adjusted life years from a 3- to a 2-hour repositioning strategy was 0.008, (95% CrI=0.005-0.016) and from a 3- to a 4-hour repositioning strategy was 0.009 (95% CrI=0.007-0.018). Repositioning at 3-hour intervals was the dominant strategy with respect to the incremental cost-effectiveness ratio against the 2- and 4-hour strategies. Sensitivity analysis showed a 99% probability that 3-hour repositioning was a dominant strategy. We concluded that repositioning at 3-hour intervals for residents at moderate or high risk of PrUs and who were cared for on high-density foam mattresses appeared to be the most cost-effective strategy.

Keywords: economic evaluation; pressure ulcers; reposition frequency.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Beds / standards
  • Cost Savings / methods
  • Female
  • Humans
  • Long-Term Care / economics*
  • Male
  • Nursing Homes / economics*
  • Patient Positioning / economics*
  • Patient Positioning / methods
  • Pressure Ulcer / economics*
  • Pressure Ulcer / prevention & control
  • Prognosis