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 Oct;17(5):1291-1299. doi: 10.1111/iwj.13390. Epub 2020 May 11.


Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high-risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi-layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom-up approach. A cost-effectiveness analysis by calculating the incremental cost-effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost-effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost-effective for the sacral area, but only marginal on heels for critically ill patients.

Keywords: cost-effectiveness; costs analysis; pressure ulcer; prevention; preventive dressings.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Bandages
  • Cost-Benefit Analysis
  • Heel
  • Humans
  • Intensive Care Units
  • Pressure Ulcer* / prevention & control
  • Sacrum
  • Silicones


  • Silicones