EUROPEAN PRESSURE ULCER ADVISORY PANEL

MEASURING COST AND QUALITY IN PRESSURE ULCER PREVENTION AND TREATMENT
Report of a Satellite Meeting held during the Fourth EPUAP Open Meeting, Pisa, 26 September 2000

Pressure ulcer prevention and treatment are typically considered to reflect important issues in both the funding and quality of healthcare. ‘Pressure ulcers are expensive’, is a common statement, and while readily accepted this is rarely backed up with hard data. If pressure ulcers are expensive, then their prevention will be less costly than treatment, again a common belief with little substance. The development of a pressure ulcer is often considered to mark low quality care, or to be an experience that reduces a person’s health-related quality of life. Such statements are common in pressure ulcer discussions but are they accurate and, if so, can these costs, both in monetary and humanitarian dimensions be quantified? These questions lay behind a satellite meeting held in Pisa last September. Jointly organised by Ronald Boumans (Netherlands), Michael Clark (Wales), Laszlo Gulacsi (Hungary) and Patricia Price (Wales), the meeting considered the development of appropriate terminologies and methodologies to both describe and count the cost of pressure ulcers.

Whilst the audience was small in number, this perhaps enabled a wider general discussion than could have been achieved through a presentation of the issues to the entire conference audience. The meeting began by considering the main forms of economic analysis; these designs capturing cost of illness, cost-minimisation, cost-effectiveness, cost-utility and cost-benefit data. Provided with these definitions, the audience considered what information they would require within their institutions and how this could be captured. These initial discussions may hopefully lead to the eventual development of an EPUAP template for studies exploring the financial costs of pressure ulcers. The organisers of the satellite meeting would welcome comment and support from other members in developing this concept of an agreed methodology for cost of pressure ulcers studies.

Turning to the area of health-related quality of life, the audience were introduced to common quality of life instruments, with discussion upon how quality of life information can be obtained where the individual cannot respond to a questionnaire, a situation unfortunately common in many cases where severe pressure ulcers are present. For the audience measuring quality of life was controversial; some considered that the healing of a pressure ulcer inevitably marked an improvement in quality of life, regardless of the tactics used to effect healing. Given this view, measurement of health-related quality of life appeared meaningless. Is this view shared by the wider membership of the EPUAP? We would welcome discussion regarding the value of quantifying health-related quality of life among people at risk of, or with pressure ulcers. If measuring quality of life is important, as believed by (at least) the organisers of the satellite meeting, how should this be most effectively undertaken?

This satellite meeting marked the introduction of the EPUAP to the methods that could be employed to generate hard data upon both the costs and consequences of pressure ulcers. We would hope that future EPUAP meetings would take this initial discussion forward, so helping the pressure ulcer community to support its common claims of high cost and low quality of life where pressure ulcers exist.