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

Objective: To determine from a societal perspective the cost-effectiveness and cost-utility of telephone-based support for management of pressure ulcers. Study design: Cost-effectiveness and cost-utility analysis of a randomised clinical trial. Setting: Tertiary centre in India and Bangladesh. Methods: An economic evaluation was conducted alongside a randomised clinical trial comparing 12 weeks of telephone-based support (intervention group) with usual care (control group). The analyses evaluated costs and health outcomes in terms of cm² reduction of pressure ulcers size and quality-adjusted life years (QALYs) gained. All costs were in Indian Rupees (INR) and then converted to US dollars (USD). Results: The mean (95% confidence interval) between-group difference for the reduction in size of pressure ulcers was 0.53 (−3.12 to 4.32) cm², favouring the intervention group. The corresponding QALYs were 0.027 (0.004–0.051), favouring the intervention group. The mean total cost per participant in the intervention group was INR 43 781 (USD 2460) compared to INR 42 561 (USD 2391) for the control group. The per participant cost of delivering the intervention was INR 2110 (USD 119). The incremental cost-effectiveness ratio was INR 2306 (USD 130) per additional cm² reduction in the size of the pressure ulcer and INR 44 915 (USD 2523) per QALY gained. Conclusion: In terms of QALYs, telephone-based support to help people manage pressure ulcers at home provides good value for money and has an 87% probability of being cost-effective, based on 3 times gross domestic product. Sensitivity analyses were performed using the overall cost data with and without productivity costs, and did not alter this conclusion.