Economic evaluations of interventions for the prevention and treatment of pressure ulcers: an umbrella review.

Objective: The objective of this review was to summarize the systematic review findings of economic evaluations to prevent or treat pressure ulcers.

Introduction: Pressure ulcers/injuries are one of the most common preventive complications characterized by local tissue injury. Pressure ulcers increase the mortality rate, impair quality of life, prolong the length of hospital stay, increase the cost of treatments, and alter general health outcomes. Published studies found higher costs in pressure ulcer treatment when compared to their prevention. Treatment costs vary depending on the pressure ulcer category (the higher the category, the higher the costs). This umbrella review systematically reviewed the evidence on pressure ulcer prevention or treatment from an economic perspective.

Inclusion criteria: Eligible systematic reviews investigating both the cost and outcomes associated with the prevention or treatment of pressure ulcers were included. Systematic reviews dealing with economic evaluation of wound care or management were excluded if they did not provide separate analyses for pressure ulcers.

Methods: We searched Epistemonikos, MEDLINE (Ovid), NHS Economic Evaluation Database, and the Canadian Agency for Drugs and Technologies in Health (CADTH) website for relevant health economic systematic reviews from inception, without any language restrictions. Titles and abstracts as well as full texts were screening independently by 2 reviewers. We assessed the methodological quality independently using the standard JBI Critical Appraisal Tool for Systematic Reviews and Research Syntheses. All health economic outcomes were considered as primary outcomes of the study.

Results: We identified 14 systematic reviews, 7 with a priori published protocols: 9 were of high quality and 5 were of moderate methodological quality. None of the systematic reviews focused primarily on the pressure ulcers' cost-effectiveness; however, all the included systematic reviews assessed cost-effectiveness, either prevention or treatment or both, with different preventive approaches and interventions. The most cost-effective prevention strategies reported multifaceted interventions, including repositioning regimens, pressure redistribution mattresses or overlays, and oral nutritional supplements. The most cost-effective treatment strategies reported for pressure ulcers were foam and collagenase dressing over saline-soaked gauze and enteral nutrition.

Conclusions: This umbrella review identified nutrition support, foam and collagenase dressing, and pressure redistribution mattresses or overlays to be most cost-effective in preventing or treating pressure ulcers in a few of the included systematic reviews, while other systematic reviews lacked sufficient data on economic outcomes to make a determination. We recommend future studies focus on well-designed, full economic evaluations addressing the question of cost-effectiveness in prevention and management of pressure ulcers, especially in terms of repositioning.

Review registration: Open Science Framework https://osf.io/9y2a7/.