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Open Access Research article

An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

Patriek Mistiaen1*, Andre Ament2, Anneke L Francke13, Wilco Achterberg4, Ruud Halfens56, Janneke Huizinga7 and Henri Post8

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands

2 Maastricht University, Department of Health Organisation Policy and Economics, PO Box 616, 6200 MD Maastricht, the Netherlands

3 EMGO Institute for Health and Care Research (EMGO+) of the VU University Medical Center Amsterdam, Department of Public and Occupational Health, van de Boechorststraat 7, 1081 ET Amsterdam, the Netherlands

4 EMGO Institute for Health and Care Research (EMGO+) of the VU University Medical Center Amsterdam, Department of Nursing Home Medicine, van de Boechorststraat 7, 1081 ET Amsterdam, The Netherlands

5 Maastricht University, Faculty of Health, Medicine and Life Sciences, PO Box 616, 6200 MD Maastricht, the Netherlands

6 Witten-Herdecke University, Fakultät für Medizin, Institut für Pflegewissenschaft, Stockumer Straße 12, 58453 Witten, Germany

7 V&VN- Dermatology, National Nursing and Caring Organisation, department for dermatology nursing, PO Box 8212, 3503 RE Utrecht, the Netherlands

8 Evean Zorg, Bristolroodstraat 164, 1503 NZ Zaandam, the Netherlands

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BMC Health Services Research 2010, 10:226  doi:10.1186/1472-6963-10-226

Published: 5 August 2010

Abstract

Background

Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home.

Methods

An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches.

Results

Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients) or €1,847 (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the estimations of the costs of pressure ulcer treatment.

Conclusions

From a nursing home perspective, the investment costs for use of the Australian Medical Sheepskin in newly admitted rehabilitation patients are larger than the monetary savings obtained by preventing pressure ulcers.