Turning High-Risk Individuals: An Economic Evaluation of Repositioning Frequency in Long-Term Care.
Turning High-Risk Individuals: An Economic Evaluation of Repositioning Frequency in Long-Term Care.
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转变高风险个体：长期护理中重新定位频率的经济评估。
DOI：
10.1111/jgs.15387
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发表时间：
2018
影响因子：
6.3
通讯作者：
Krahn,Murray
中科院分区：
文献类型：
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作者：
Pechlivanoglou,Petros;Paulden,Mike;Pham,Ba';Wong,Josephine;Horn,SusanD;Krahn,Murray
最近的证据表明，对于患有中度至高度压疮（PrU）风险的长期护理居民，减少重新定位的频率在预防压疮（PrU）方面并不劣于当前的重新定位标准，但减少重新定位频率的长期健康和经济后果尚未得到充分估计。我们的目标是估计不同重新定位策略（2、3、4小时间隔）的成本效益。我们根据随机临床试验和文献的数据，使用寿命范围进行了成本效用分析。我们更新了已发表的PrU决策模型，包括文献和小型观察性研究中的资源使用、单位成本和流行病学估计。从安大略卫生和长期护理部的角度进行了研究。我们估计，3小时重新定位比2小时重新定位每个居民的寿命成本少5，425加元（95%可信区间（CrI）= 922 - 12，166美元），比4小时重新定位少3，296加元（95% CrI= 483 - 9，738美元）。从3至2小时重新定位策略的预期质量调整生命年增加为0.008（95% CrI=0.005-0.016），从3至4小时重新定位策略的预期质量调整生命年增加为0.009（95% CrI=0.007-0.018）。相对于2小时和4小时策略，以3小时间隔重新定位是增量成本效益比的主导策略。敏感性分析显示，3小时重新定位是主导策略的概率为99%。我们的结论是，对于中度或高度PrU风险的居民以及在高密度泡沫床垫上护理的居民，每隔3小时重新定位似乎是最具成本效益的策略。
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.