Abstract
More than 2.5 million people in the United States develop pressure injuries annually, which are one of the most common complications occurring in hospitals. Despite being common, hospital-acquired pressure injuries (HAPIs) are largely considered preventable by regular patient turning. Although current methodologies to prompt on-time repositioning have limited efficacy, a wearable patient sensor has been shown to optimize turning practices and improve clinical outcomes. The purpose of this study was to assess the cost-effectiveness of patient-wearable sensor in the prevention of HAPIs in acutely ill patients when compared to standard practice alone. A decision analytic model was developed to simulate the expected costs and outcomes from the payer’s perspective using data from published literature, including a recently published randomized controlled trial. Both univariate and probabilistic sensitivity analysis were conducted. The patient-wearable sensor was found to be cost saving (dominant). It resulted in better clinical outcomes (77% reduction in HAPIs) compared to standard care and an expected cost savings of $6,621 per patient over a one-year period. Applying the model to a cohort of 1,000 patients, an estimated 203 HAPIs would be avoided with annualized cost reduction of $6,222,884 through all patient treatment settings. The probabilistic analysis returned similar results. In conclusion, the patient-wearable sensor was found to be cost-effective in the prevention of HAPIs and cost-saving to payers and hospitals. These results suggest that patient-wearable sensors should be considered as a cost-effective alternative to standard care in the prevention of HAPIs.
Highlights
In 2019, the Agency for Healthcare Research and Quality reported that hospital-acquired pressure injuries (HAPIs) had increased by 6% over 2014 baseline, whereas all other hospital-acquired conditions decreased by an average of 13% over their 2014 baseline rates (Bysshe et al, 2017)
Switching patient practice from standard care alone to adding a patient-wearable sensor on top of standard care would result in an expected cost saving of $6,621 per patient, and an expected reduction in HAPI incidence of 77% over 52 weeks
Even when we explored the possibility of patients needing more than one sensor, in this case applying multiple sensors per patient, the patient-wearable sensor remained cost saving, suggesting the model is not sensitive to this assumption
Summary
In 2019, the Agency for Healthcare Research and Quality reported that HAPIs had increased by 6% over 2014 baseline, whereas all other hospital-acquired conditions (including falls, ventilator-associated pneumonias, and central line-associated bloodstream infections) decreased by an average of 13% over their 2014 baseline rates (Bysshe et al, 2017). Routine patient repositioning has been shown to strongly correlate with lower incidence of HAPI (Bergquist-Berenger et al, 2013) and is a recommended clinical practice to prevent pressure injuries for all at-risk patients (EPUAP/NPIAP/PPPIA, 2019). Most recent guidelines recommend repositioning all patients at risk for pressure injuries in a way that offers optimal offloading of all bony prominences and maximizes pressure redistribution (EPUAP/NPIAP/PPPIA, 2019). Turn protocols have required adherence to a 2-h repositioning interval, yet multiple studies show that this standard is rarely met. Studies examining adherence to turn protocols have estimated it to be between 10% (Winkelman et al, 2010) and 64% (Schutt et al, 2017)
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