PMD22 COST-EFFECTIVENESS ANALYSIS OF THREE WOUND DRESSINGS FOR THE TREATMENT OF PRESSURE ULCERS FROM THE PUBLIC HOSPITAL PERSPECTIVE

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Each year in Brazil, 42.3% of all inpatients present skin ulcers during the hospitalization period. Current clinical practice guidelines have not established a gold standard protocol of care for pressure ulcers. Thus, this study aimed to develop cost-effectiveness analysis comparing three different dressings: hydrocolloid, silver sulfadiazine 1% cream (SSD) and saline gauze (SG), under the perspective of Brazilian public hospitals. The mean time to healing (MTH) for each protocol was obtained from systematic reviews. Data from the Brazilian Hospital Information System from January 1st to December 31st 2009 was used to define the annual number of hospital admissions due to pressure ulcers (only non-surgical records with L89 ICD-10 code were included). The model assumed that SG is the current practice in Brazilian public hospitals and patients are discharged at the time their wound heals. The difference in MHT was applied to the average length of stay (LOS) reported in the database. Resource use was estimated through expert panel and unit costs were obtained from Brazilian official price lists. 934 hospitalizations were identified with mean LOS of 13.72 days. Hydrocolloid and SSD would reduce the MHT in 4.72 and 2.72 days, thus reducing patients' LOS. The cost per change was estimated as 15.52BRL, 43.20BRL and 15.72BRL and the cost per protocol per patient (daily room charges and dressing changes) was 902.50BRL, 559.61BRL and 907.99BRL, for SG, hydrocolloid and SSD, respectively. Adopting hydrocolloid as wound management protocol would save −342.89BRL per patient and -BRL320,259 for the 2009 cohort. SSD projected savings was −5.49BRL per patient and -BRL5,125.79 for the entire cohort. Hydrocolloid dressing has shown higher efficacy when compared to SG or SSD dressings, with fewer costs. The clinical and economic incremental results between different dressings reinforce the need of evidence-based decision making and rational resource allocation.