Telephone Support for Pressure Ulcer Management

A study of tertiary centres In Bangladesh and India examined the cost utility and cost-effectiveness of telephone-based support for pressure ulcer management in individuals with SCI (Arora et al. 2017). This study was conducted concurrently with a randomized clinical trial. The researchers adopted a societal perspective. The outcomes of interest were the decrease in pressure ulcer size and changes in quality of life (measured by the EQ-5D) at 12 weeks. Resources such as the cost of pressure ulcer management equipment and resources and lost-productivity from work were collected through participant diaries and included purchases and time spent on pressure ulcer treatment related activities. Intervention costs (including telephone calls, health professionals, administrator and trainer time) accrued by the centres were also collected. Results were reported in 2015 Indian Rupees (INR). At time of follow-up there was a pressure ulcer size reduction of 0.53 cm2 for the telephone-based support cohort compared to the control group. There was also an incremental QALY of 0.027 in favour of the intervention arm. The total cost per person was 43,781 INR for the intervention arm and 42,561 for the control group. The incremental cost effectiveness ratio was 2,306 INR per additional cm2 reduction in pressure ulcer size, 44,915 INR per QALY. The probabilistic sensitivity analyses show that there is an 87% probability that the intervention is cost-effective with a willingness to pay of 3 times per capital gross domestic product (GDP) (331,650 INR). The model was observed to be sensitive to the cost of lost productivity resulting from time spent on treatment related activities. The authors conclude that the telephone-based support program provided “good value for money”.