HEALTH POLICY/ORIGINAL RESEARCH Early Prevention of Pressure Ulcers Among Elderly Patients Admitted Through Emergency Departments: A Cost-effectiveness Analysis Ba’ Pham, MSc, PhD (c), Laura Teague, RN-EC, MN, James Mahoney, MD, Laurie Goodman, RN, MHScN, Mike Paulden, MSc, MA(Cantab), Jeff Poss, PhD, Jianli Li, PhD, Luciano Ieraci, MSc, Steven Carcone, MSc, Murray Krahn, MD, MSc From the Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada (Pham, Paulden, Ieraci, Carcone, Krahn); the Wound Care Program (Teague), the Division of Plastic Surgery, Department of Surgery (Mahoney), and Skin and Wound Care, Credit Valley Hospital, Mississauga, Ontario, Canada (Goodman); the Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada (Poss); and Decision Support Services, St. Michael’s Hospital, Toronto, Ontario, Canada (Li). Study objective: Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients. Methods: Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon. Results: The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was $0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of $32 per patient. If decisionmakers are willing to pay $50,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses ($3,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty. Conclusion: The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs. [Ann Emerg Med. 2011;58:468-478.] Please see page 469 for the Editor’s Capsule Summary of this article. Provide feedback on this article at the journal’s Web site, www.annemergmed.com. A podcast for this article is available at www.annemergmed.com. 0196-0644/$-see front matter Copyright © 2011 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2011.04.033 SEE EDITORIAL, P. 479. INTRODUCTION Background Pressure ulcers may develop when persisting pressure on bony prominences obstructs healthy capillary flow, leading to tissue necrosis. 1 Elderly patients are at high risk of developing pressure ulcers because of immobility, 2-4 poor nutritional status, 3 impaired mental status, 5 and incontinence. 2,5 Annually, elderly patients account for 30% of the 117 million emergency department (ED) visits, resulting in 6.2 million admissions to US hospitals. 6 Elderly admitted patients typically spend hours in the EDs, especially during crowded periods. 6,7 Before admission, these patients could be at risk of developing pressure ulcers because they lie for considerable time on unyielding diagnostic equipment surfaces, stretchers, and standard hospital mattresses. 8 Baumgarten et al 2 prospectively studied 3,233 elderly admitted ED patients. Approximately 6% of these patients 468 Annals of Emergency Medicine Volume , .  : November 