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Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury
Authors:Mittmann Nicole  Chan Brian C  Craven B Cathy  Isogai Pierre K  Houghton Pamela
Affiliation:aHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada;bDepartment of Pharmacology, University of Toronto, Toronto, ON, Canada;cDepartment of Medicine and Health Policy Management and Evaluation, Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada;dSchool of Physical Therapy, University of Western Ontario, London, ON, Canada
Abstract: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.

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.
Keywords:Electric stimulation   Economics   Pressure ulcer   Rehabilitation   Spinal cord injuries
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