Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost‐effectiveness analysis of the ‘TEAM‐UP’ clinical trial

Abstract

AbstractPressure injury (PrI) prevention guidelines recommend 2‐h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost‐effectiveness of PrI prevention protocols with 2‐, 3‐ and 4‐h repositioning intervals in US nursing homes according to ‘Turn Everyone and Move for Ulcer Prevention’ (TEAM‐UP) randomized controlled trial findings. Markov modelling compared 2‐, 3‐ and 4‐h repositioning intervals, controlling for other practice guidelines, to prevent PrIs in nursing home residents from a US health sector perspective over one year using TEAM‐UP trial data for model structure, sampling and parameterization. Costs, captured in 2020 US dollars, and quality‐adjusted life years (QALYs) were used to derive an incremental cost‐effectiveness ratio and net monetary benefit (NMB) at $50 000/QALY‐$150 000/QALY cost‐effectiveness thresholds. Sensitivity analyses tested model uncertainty. Repositioning intervals between 3 and 4 h were cost‐effective based on reduced costs at slightly lower QALYs than 2 h at a $50 000/QALY threshold, and the NMB of 4‐h repositioning was also more efficient than at 3 h ($9610). Repositioning labour cost and prevention routines were among the most sensitive parameters. Sensitivity analyses demonstrated that 3‐ and 4‐h intervals were cost‐effective in over 65% of simulations at any cost‐effectiveness threshold. Repositioning intervals of 3 to 4 h have potential to reduce nursing time costs without significant decrements in clinical benefits to nursing home residents. Clinical guidelines for PrI prevention should be updated to reflect TEAM‐UP clinical and economic findings. Facilities can use cost‐savings recuperated from nursing time to deploy to other patient safety priorities without seriously jeopardizing PrI safety.