Article

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.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS