Evaluation of the Cost-Effectiveness of Electrical Stimulation Therapy for Pressure Ulcers in Spinal Cord Injury

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.ObjectiveTo 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.DesignA 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.SettingThe perspective of this analysis is from a Canadian public health system payer.ParticipantsModel target population was an SCI cohort with grade III/IV PUs.InterventionsNot applicable.Main Outcome MeasureIncremental cost per PU healed.ResultsES 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.ConclusionsThe addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population.