Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh

Arora, Mohit; Harvey, L A; Glinsky, Joanne; Chhabra, Harvinder Singh; Hossain, Mohammad Sohrab; Arumugam, Narkeesh; Bedi, Parneet Kaur; Cameron, Ian D.; Hayes, Alison

doi:10.1038/sc.2017.87

Cited by 18 publications

(50 citation statements)

References 17 publications

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“…Medico-economic evaluations of telemedicine are still lacking in number and quality (13), and cost-effectiveness studies of telemedicine for wound management are even rarer (14)(15)(16). We identified in the literature only three economic evaluations of wound telemedicine based on randomized controlled trials (RCTs).…”

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confidence: 99%

“…We identified in the literature only three economic evaluations of wound telemedicine based on randomized controlled trials (RCTs). The work of Arora et al (14) concerned an economic evaluation for the management of ulcers at home with telephone-based advice for 12 weeks (group intervention). The results showed a reduction in size of pressure ulcers for the intervention group compared with the traditional practice, an improvement of quality-adjusted life-years but a greater cost of the telephone-based advices.…”

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confidence: 99%

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Real-World Clinical Evaluation and Costs of Telemedicine for Chronic Wound Management

Goff-Pronost¹,

Mourgeon²,

Blanchère³

et al. 2018

Int J Technol Assess Health Care

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Background:Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home.Objectives:The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months.Methods:We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations.Results:Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p < .05). The percentage of wounds completely healed was not statistically different between the telemedicine and control group (66 percent versus 61 percent; p > .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months.Conclusions:This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.

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confidence: 99%

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confidence: 99%

Real-World Clinical Evaluation and Costs of Telemedicine for Chronic Wound Management

Goff-Pronost¹,

Mourgeon²,

Blanchère³

et al. 2018

Int J Technol Assess Health Care

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“…The following is a summary of the characteristics of the selected studies included in this review. 6,11,[22][23][24][25][26][27][28][29][30][31] The affiliated institution, country of origin, study title, study objectives, journals in which they were published, along with digital object identifier numbers and date of articles' first submission were extracted. After agreement by coauthors, studies were included, following independent search and screening efforts without the assistance of a librarian.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…27,28 Age was reported in years by mean with standard deviation, among seven studies according to intervention (range 29-51.5) and control (range 38-52.8) groups. 6,11,22,23,27,28,31 Ten studies focused strictly on SCI, whereas one study included multiple sclerosis (MS). 23 One study included MS and amputees, 28 whereas another study included MS, cerebral palsy (CP), stroke, spina bifida, and lupus.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

Substantiating Clinical Effectiveness and Potential Barriers to the Widespread Implementation of Spinal Cord Injury Telerehabilitation: A Systematic Review and Qualitative Synthesis of Randomized Trials in the Recent Past Decade

Lee

Kim

2021

Telemedicine Reports

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Introduction: Telemedicine across many specialties in clinical practice has been established in the literature regarding technology platforms, privacy issues, cost, and clinical effectiveness. However, the lack of data in these areas applicable to spinal cord injury telerehabilitation (teleSCI) still exists. The gaps in these knowledge areas continue to hinder its widespread implementation and serve as pathways for focused efforts in teleSCI research. Objective: This systematic review aims to substantiate the clinical effectiveness and potential barriers to teleSCI implementation by verifying the statistical significance of various clinical outcomes from randomized trials published within the recent past decade. Methods: A qualitative synthesis of randomized studies, conducted across various regions, was systematically reviewed after identifying relevant records from database search engines. Applied filters in the search included publication dates (2010-2020), humans, full-text, and no language preference. The 13 studies were selected per Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram, and the risk of bias across studies was evaluated by using the Physiotherapy Evidence Database scale of quality assessment. Results: Quantitative outcome measurements demonstrated positive impact across studies: 79.1% (34/43) of all measurements were statistically significant for positive outcomes and 18.6% (8/43) yielded no effect but were significant. Primary outcomes addressed various spinal cord injury (SCI) management areas; 38.5% (5/13) of studies also assessed secondary outcomes. Interventional platforms were conventional technologies used in telemedicine. One study (7.7%) achieved data encryption; no studies presented cost-analysis data. Conclusion:The majority of studies demonstrated significant positive outcomes to validate teleSCI clinical effectiveness through conventional technology. These results further expand our understanding of teleSCI's impact and its demonstrated potential for improving SCI individuals' lives. However, heterogeneity of selected studies limits the conclusive recommendations to address potential barriers to its widespread implementation. Moreover, the development of new data is warranted to promote ''buy-in'' of widespread teleSCI implementation.

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“…6 In addition to the increased morbidity, pressure ulcers have a significant cost impact, 7 imposing a huge financial burden on both individuals and healthcare systems in developing and developed countries. The mean cost to treat pressure ulcer injuries in India is significantly higher than its per capita income ($2460 versus $1670), 8,9 while in developed countries like the UK, it ranges from £1214 (stage 1) to £14,608 (stage 4). 10 The risk of HAPUs has traditionally been minimized by turning the patient once every 2 h, alternating lateral and supine positions, commonly referred to as turn protocol.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India

Renganathan

Nagaiyan

Preejith

et al. 2018

Journal of the Intensive Care Society

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Purpose Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance. Methods We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)). Results We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001. Conclusion Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.

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Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh

Cited by 18 publications

References 17 publications

Real-World Clinical Evaluation and Costs of Telemedicine for Chronic Wound Management

Real-World Clinical Evaluation and Costs of Telemedicine for Chronic Wound Management

Substantiating Clinical Effectiveness and Potential Barriers to the Widespread Implementation of Spinal Cord Injury Telerehabilitation: A Systematic Review and Qualitative Synthesis of Randomized Trials in the Recent Past Decade

Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India

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