期刊
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
卷 92, 期 6, 页码 866-872出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2010.12.038
关键词
Electric stimulation; Economics; Pressure ulcer; Rehabilitation; Spinal cord injuries
资金
- Ontario Neurotrauma Foundation
- Roseau provincial de recherche en adaptation-readaptation [2008-ONF-REPAR-601]
Mittmann N, Chan BC, Craven BC, Isogai PK, Houghton P. Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury. Arch Phys Med Rehabil 2011;92:866-72. Objective: To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective. Design: A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted. Setting: The perspective of this analysis is from a Canadian public health system payer. Participants: Model target population was an SCI cohort with grade III/IV PUs. Interventions: Not applicable. Main Outcome Measure: Incremental cost per PU healed. Results: ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC. Conclusions: The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population.
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