Cost-effectiveness analysis of nutritional support for the prevention of pressure ulcers in high-risk hospitalized patients
Abstract
Objective To evaluate the cost-effectiveness of nutritional support compared with standard care in preventing pressure ulcers (PrUs) in high-risk hospitalized patients. Design An economic model using data from a systematic literature review. A meta-analysis of randomized controlled trials on the efficacy of nutritional support in reducing the incidence of PrUs was conducted. Patients Modeled cohort of hospitalized patients at high risk of developing PrUs and malnutrition simulated during their hospital stay and up to 1 year. Interventions Standard care included PrU prevention strategies, such as redistribution surfaces, repositioning, and skin protection strategies, along with standard hospital diet. In addition to the standard care, the intervention group received nutritional support comprising patient education, nutrition goal setting, and the consumption of high-protein supplements. Main outcomes measures The analysis was from a healthcare payer perspective. Key outcomes of the model included the average costs and quality-adjusted life years. Model results were tested in univariate sensitivity analyses, and decision uncertainty was characterized using a probabilistic sensitivity analysis. Main results Compared with standard care, nutritional support was cost saving at AU $425 per patient and marginally more effective with an average 0.005 quality-adjusted life years gained. The probability of nutritional support being cost-effective was 87%. Conclusions Nutritional support…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a meta-analysis of RCTs on hospitalized patients at high risk of developing pressure ulcers, by Tuffaha et al., provision of nutritional support resulted in a cost saving of 425 $ per patient and a marginal improvement of quality adjusted life years of 0.005, compared to usual care.
“Positive results were also reported in a meta-analysis of RCTs on hospitalized patients at high risk of developing pressure ulcers, by Tuffaha et al.Provision of nutritional support resulted in a cost saving of 425 $ per patient and a marginal improvement of quality adjusted life years of 0.005, compared to the usual care [48] (Level of evidence 1þþ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [48]
Cites
Nutritional Assessment: A Comparison of Clinical Judgment and Objective Measurements
Baker, J. P., Detsky, A. S., Wesson, D. E., Wolman, S. L., Stewart, S., Whitewell, J., Langer, B., & Jeejeebhoy, K. N. (1982) · New England Journal of Medicine · doi:10.1056/nejm198204223061606 · Cited by 1,019 · see citing works
Dietary supplementation in elderly patients with fractured neck of the femur
Delmi, M., Rapin, C. H., Bengoa, J., Bonjour, J.-P., Vasey, H., & Delmas, P. D. (1990) · The Lancet · doi:10.1016/0140-6736(90)91073-j · Cited by 825 · see citing works
Briggs, A. H., Weinstein, M. C., Fenwick, E. A. L., Karnon, J., Sculpher, M. J., & Paltiel, A. D. (2012) · Value in Health · doi:10.1016/j.jval.2012.04.014 · Cited by 711 · see citing works
Patient risk factors for pressure ulcer development: Systematic review
Coleman, S. B., Rutherford, C., Nelson, E. A., Closs, S. J., Defloor, T., Halfens, R. J. G., Farrin, A. J., Brown, J. M., Schoonhoven, L., & Nixon, J. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.11.019 · Cited by 711 · see citing works
A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments
Hawthorne, G., Richardson, J. R. J., & Day, N. (2001) · Annals of Medicine · doi:10.3109/07853890109002090 · Cited by 470 · see citing works
The cost of pressure ulcers in the United Kingdom
Dealey, C., Posnett, J. W., & Walker, A. (2012) · Journal of Wound Care · doi:10.12968/jowc.2012.21.6.261 · Cited by 427 · see citing works
Briggs, A. H., Goeree, R. A., Blackhouse, G., & O’Brien, B. J. (2002) · Medical Decision Making · doi:10.1177/0272989x0202200408 · Cited by 413 · see citing works
VanGilder, C. A., Amlung, S., Harrison, P., & Meyer, S. (2009) · PubMed · Cited by 363 · see citing works
The Epidemiology and Natural History of Pressure Ulcers in Elderly Nursing Home Residents
Brandeis, G. H. (1990) · JAMA · doi:10.1001/jama.1990.03450220071025 · Cited by 323 · see citing works
Stratton, R. J., Ek, A., Engfer, M., Moore, Z. E. H., Rigby, P., Wolfe, R. A., & Elia, M. (2005) · Ageing Research Reviews · doi:10.1016/j.arr.2005.03.005 · Cited by 305 · see citing works
Allman, R. M., Goode, P. S., Burst, N. M., Bartolucci, A. A., & Thomas, D. (1999) · PubMed · Cited by 274 · see citing works
Treatment of Pressure Ulcers: A Systematic Review
Reddy, M., Gill, S. S., Kalkar, S. R., Wu, W., Anderson, P. J., & Rochon, P. A. (2008) · JAMA · doi:10.1001/jama.2008.778 · Cited by 266 · see citing works
PRESSURE ULCERS IN AMERICA: Prevalence, Incidence, and Implications for the Future
&NA; (2001) · Advances in Skin & Wound Care · doi:10.1097/00129334-200107000-00015 · Cited by 258 · see citing works
Bourdel‐Marchasson, I., Barateau, M., Rondeau, V., Dequae-Merchadou, L., Salles, N., Émeriau, J. P., Manciet, G., & Dartigues, J. (2000) · Nutrition · doi:10.1016/s0899-9007(99)00227-0 · Cited by 232 · see citing works
The development and healing of pressure sores related to the nutritional state
Ek, A. ‐., Unosson, M., Larsson, D. G. J., von Schenck, H., & Bjurulf, P. (1991) · Clinical Nutrition · doi:10.1016/0261-5614(91)90002-t · Cited by 219 · see citing works
Harris, A., Hill, S. R., Chin, G., Li, J. J., & Walkom, E. J. (2008) · Medical Decision Making · doi:10.1177/0272989x08315247 · Cited by 216 · see citing works
Improving the Quality of Pressure Ulcer Care With Prevention
Padula, W. V., Mishra, M. K., Makic, M. B. F., & Sullivan, P. W. (2011) · Medical Care · doi:10.1097/mlr.0b013e31820292b3 · Cited by 171 · see citing works
Houwing, R. H. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(03)00039-6 · Cited by 167 · see citing works
Malnutrition and pressure ulcer risk in adults in Australian health care facilities
Banks, M., Bauer, J. D., Graves, N., & Ash, S. (2009) · Nutrition · doi:10.1016/j.nut.2009.09.024 · Cited by 160 · see citing works
Clemens, S., Begum, N., Harper, C., Whitty, J. A., & Scuffham, P. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0676-x · Cited by 145 · see citing works
Self-citationMalnutrition in hip fracture patients: an intervention study
Olofsson, B., Stenvall, M., Lundström, M., Svensson, O., & Gustafson, Y. (2007) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2006.01864.x · Cited by 138 · see citing works
Essex, H. N., Clark, M., Sims, J., Warriner, A., & Cullum, N. A. (2009) · Wound Repair and Regeneration · doi:10.1111/j.1524-475x.2009.00544.x · Cited by 133 · see citing works
Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial
Hartgrink, H. H., Wille, J. C., König, P., Hermans, J., & Breslau, P. J. (1998) · Clinical Nutrition · doi:10.1016/s0261-5614(98)80321-x · Cited by 132 · see citing works
Hoekstra, J. C., Goosen, J. H. M., de Wolf, G. S., & Verheyen, C. C. P. M. (2011) · Clinical Nutrition · doi:10.1016/j.clnu.2011.01.011 · Cited by 125 · see citing works
Modeling the economic losses from pressure ulcers among hospitalized patients in Australia
Graves, N., Birrell, F. A., & Whitby, M. (2005) · Wound Repair and Regeneration · doi:10.1111/j.1067-1927.2005.00066.x · Cited by 108 · see citing works
Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals
Banks, M., Graves, N., Bauer, J. D., & Ash, S. (2012) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2012.140 · Cited by 75 · see citing works
The prevalence and incidence of chronic wounds: A literature review
Graves, N., & Zheng, H. Y. (2014) · Wound Practice & Research: Journal of the Australian Wound Management Association · Cited by 72 · see citing works
Preventing Pressure Ulcers in Long-term Care
Pham, B. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.473 · Cited by 71 · see citing works
The costs arising from pressure ulcers attributable to malnutrition
Banks, M., Graves, N., Bauer, J. D., & Ash, S. (2009) · Clinical Nutrition · doi:10.1016/j.clnu.2009.08.006 · Cited by 58 · see citing works
Scott, I. A., Brand, C. A., Phelps, G. E., Barker, A. L., & Cameron, P. A. (2011) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2011.tb03150.x · Cited by 55 · see citing works
Tuffaha, H., Roberts, S., Chaboyer, W. P., Gordon, L. G., & Scuffham, P. (2015) · Applied Health Economics and Health Policy · doi:10.1007/s40258-015-0152-y · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
1 of the 32 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Muñoz, N., Posthauer, M. E., Cereda, E., Schols, J. M. G. A., & Haesler, E. (2020) · Advances in Skin & Wound Care · doi:10.1097/01.asw.0000653144.90739.ad · Cited by 149 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“…RCTs on hospitalized patients at high risk of developing pressure ulcers, by Tuffaha et al. Provision of nutritional support resulted in a cost saving of 425 $ per patient and a marginal improvement of quality adjusted life years of 0.005, compared to the usual care [48] (Level of evidence 1 þþ ).”
InfluentialESPEN practical guideline: Nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schüetz, P., Stumpf, F., Austin, P. D., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J. M., Laviano, A., Norman, K., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.01.008 · Cited by 48 · see citing works
Muñoz, N., & Posthauer, M. E. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10762 · Cited by 41 · see citing works
Roberts, S., Hopper, Z., Chaboyer, W. P., González, R., Banks, M., Desbrow, B., & Marshall, A. P. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-5017-x · Cited by 21 · see citing works
Self-citationS3-Leitlinie Klinische Ernährung und Hydrierung im Alter
Volkert, D., Bauer, J. M., Benzinger, P., Eglseer, D., Frühwald, T., Gehrke, I., Kiesswetter, E., Lenzen-Großimlinghaus, R., Wirth, R., & (DGG), I. Z. M. D. F. W. F. A. K. E. (. F. K. E. D. S. (. G. F. G. E. V. (2025) · Aktuelle Ernährungsmedizin · doi:10.1055/a-2548-7209 · Cited by 12 · see citing works
Wong, A., Goh, G., Banks, M., & Bauer, J. D. (2018) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1431 · Cited by 12 · see citing works
Litchford, M. D. (2020) · Advances in Skin & Wound Care · doi:10.1097/01.asw.0000688412.05627.96 · Cited by 12 · see citing works
PREVALENCE, PREVENTION, AND WOUND CARE OF PRESSURE INJURY IN STROKE PATIENTS IN THE NEUROLOGY WARD
Riandini, R., Emaliyawati, E., & Mirwanti, R. (2018) · Belitung Nursing Journal · doi:10.33546/bnj.555 · Cited by 6 · see citing works
Assessment, management and prevention of chronic wounds in the Australian context: a scoping review
Bui, U. T., Tehan, P. E., Barakat‐Johnson, M., Carville, K., Haesler, E., Lazzarini, P. A., Twigg, S. M., Parker, C. N., & Finlayson, K. J. (2023) · Wound Practice and Research · doi:10.33235/wpr.31.3.120-145 · Cited by 5 · see citing works
Choi, Y., & Kim, S. R. (2021) · International Journal of Nursing Practice · doi:10.1111/ijn.12919 · Cited by 4 · see citing works
Walker, R., Chaboyer, W. P., Thalib, L., Latimer, S. L., Tuffaha, H., Cooke, M. L., & Gillespie, B. M. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105258 · Cited by 3 · see citing works
Self-citationPESQUISA QUALITATIVA EXPLORATÓRIO-DESCRITIVA: UMA BREVE DISCUSSÃO TEÓRICA
Silva, K. C. O., & Pohlmann, P. (2021) · doi:10.22533/at.ed.5882104031 · Cited by 2 · see citing works
Baron, M. V., Itaquy, V. P., dos Santos, T. G., da Silveira, J. B., Gelb, G. T., Nerys, F., & da Costa, B. E. P. (2020) · Práticas Educativas Memórias e Oralidades - Rev Pemo · doi:10.47149/pemo.v2i1.3581 · Cited by 2 · see citing works
OS SENTIDOS DO TRABALHO PARA PROFISSIONAIS DA SAÚDE DO CTI DE UM HOSPITAL UNIVERSITÁRIO
Caram, C. D. S., Rezende, L. C., & Brito, M. J. M. (2021) · doi:10.22533/at.ed.58821040315 · Cited by 1 · see citing works
Montoya, S. M., Berruecos, Y. A., Villada, O. A., & García, N. (2022) · Revista chilena de nutrición · doi:10.4067/s0717-75182022000300325 · Cited by 1 · see citing works
Cheung, V. H. I., & Wan, C. S. (2025) · Nutrients · doi:10.3390/nu17182970 · Cited by 3 · see citing works
Palau-Ferrè, A. M., & Russolillo, G. (2017) · Revista Española de Nutrición Humana y Dietética · doi:10.14306/renhyd.21.2.432 · Cited by 1 · see citing works
EDUCAÇÃO PERMANENTE EM SALA DE VACINA: UMA NECESSIDADE PRIMORDIAL DO ENFERMEIRO
Macedo, R. R. P. (2021) · doi:10.22533/at.ed.5882104038 · Cited by 1 · see citing works
Research status and hotspots of economic evaluation in nursing by co-word clustering analysis
Liao, Y., & Gao, G. (2019) · Frontiers of Nursing · doi:10.2478/fon-2019-0031
O SISTEMA MANCHESTER DE CLASSIFICAÇÃO DE RISCO: UMA REVISÃO SISTEMÁTICA
Brito, E. A., Araruna, J. B., & da Silva, M. R. (2021) · doi:10.22533/at.ed.58821040312
O IMPACTO DA GRADUAÇÃO NA QUALIDADE DE VIDA DO ESTUDANTE DE MEDICINA
Campos, L. D. S., da Silva, I. C., Araújo, T. D. M. F. D., Molin, G. F. D., & Mansur, O. M. F. D. C. (2021) · doi:10.22533/at.ed.58821040320
Ramalho, A. D. O., Freitas, P. D. S. S., & Rezende, L. D. A. (2021) · doi:10.22533/at.ed.5882104035
Chaves, F. D. S., de Araujo, I. V., Tinoco, D. L., do Nascimento, C. L., & TEIXEIRA, P. G. (2021) · doi:10.22533/at.ed.5882104032
HEALTH PHENOMENA AND RESILIENT PERSONALITY IN UNIVERSITY HEALTH PROFESSORS
da Silva, R. M., Kimura, C. A., Mussi, F. C., Soares, G. A. V., Valóta, I. A. D. C., Giotto, A. C., Saura, A. P. N. S., & Pinheiro, G. Q. (2021) · doi:10.22533/at.ed.58821040318
Amaral, A. R., & da Costa, F. R. (2021) · doi:10.22533/at.ed.58821040319
O USO DA FITOTERAPIA NO NORDESTE NO ÂMBITO DO SUS: REVISÃO INTEGRATIVA
Moreno, A. N. D. S., & Batista, C. D. S. (2021) · doi:10.22533/at.ed.58821040321
A CULTURA DE SEGURANÇA DO PACIENTE EM AMBIENTE HOSPITALAR: IMPORTÂNCIA E PERSPECTIVAS
de Queiroz, B. F. S., da Costa, M. D. M. S., Sousa, A. D. S., Bezerra, C. F., Soares, T. R., da Silva, T. C., da Silva, P. R. R., Santos, P. F., Sales, A. J. S., Maia, M. J. A., et al. (2021) · doi:10.22533/at.ed.5882104033
A INOVAÇÃO COMO IMPORTANTE FERRAMENTA PARA A TOMADA DE DECISÃO ORGANIZACIONAL
do Lago, P. N., Corrêa, C. F., Silva, D. K. D. A., Silva, F. C. D., Sipoli, I. C. D. C., Batista, L. M., Silva, M. S. E., Cutrim, D. L., Teixeira, D., Albuquerque, G. P. X., et al. (2021) · doi:10.22533/at.ed.58821040313
da Silva, D. V., Ferreira, M. C. D. M., de Mendonça, G. S., Giuliani, C. D., & Junqueira, M. A. D. B. (2021) · doi:10.22533/at.ed.58821040316
Czaika, E. C., Lentsck, M. H., Alves, J. N. B., Dvulathca, F., Brauna, J. G., & Soares, L. G. (2021) · doi:10.22533/at.ed.5882104039
IMPACTO ECONÔMICO DE PREVENÇÃO E TRATAMENTO DE LESÕES POR PRESSÃO: REVISÃO INTEGRATIVA
Freitas, P. D. S. S., Laranjeiras, A. D. S., Rezende, L. D. A., Partelli, A. N. M., Coelho, M. P., & Ramalho, A. D. O. (2021) · doi:10.22533/at.ed.58821040314
PROGRAMA DE EDUCAÇÃO PELO TRABALHO - INTERPROFISSIONALIDADE/ SAÚDE MENTAL: UM RELATO DE EXPERIÊNCIA
Figueiredo, L. M. V., dos Santos, N. C., Bittencourt, M. N., Rézio, L. D. A., & Volp, A. C. P. (2021) · doi:10.22533/at.ed.58821040310
CULTURA DE SEGURANÇA DO PACIENTE NO CONTEXTO HOSPITALAR: UMA REFLEXÃO TEÓRICA
Ribeiro, A. M. N., Cardoso, L. D. S., Nascimento, I. C. D. S., Dantas, J. D. M., de Amorim, M. D. S. R., Magalhães, N. A., Nery, E. L., Castro, M. C. D. O., Pinto, D. C. C., Santos, F. P., et al. (2021) · doi:10.22533/at.ed.5882104034
Bezerra, D. D. S., Pinto, I. V., & Souza, G. L. D. A. (2021) · doi:10.22533/at.ed.5882104037
de Mello, A. X. R., Mota, A. V., de Cerqueira, M. D. R. A., & de Abreu, L. P. (2021) · doi:10.22533/at.ed.5882104036
CHANGES IN NURSING STUDENTS’ HEALTH ONE YEAR AFTER STARTING THE NURSING DEGREE PROGRAM
da Silva, R. M., Costa, A. L. S., Heitkemper, M. M., Kimura, C. A., Garcia, K. R., dos Santos, O. P., Abreu, C. R. D. C., de Oliveira, J. L. A. S., & Benito, L. A. O. (2021) · doi:10.22533/at.ed.58821040317
Piovacari, S. M. F., dos Santos, G. Q., Moraes, J., Costa, V., Nogueira, P., & Castro, M. G. (2022) · Braspen Journal · doi:10.37111/braspenj.2022.37.1.01
Kim, Y. R., Jang, M., & Park, J. H. (2025) · Clinical Nutrition Research · doi:10.7762/cnr.2025.14.4.241
- Authors
- Tuffaha, H. W., Roberts, S., Chaboyer, W., Gordon, L. G., & Scuffham, P. A.
- Affiliations
- Griffith University (AU)
- Ministry of Health (SG)
- Venue
- Advances in Skin & Wound Care
- Published
- 2016-06
- Volume
- 29
- Issue
- 6
- Pages
- 261-267
- ISSN
- 1527-7941 (ISSN-L)
- OpenAlex
- W2361145472
- Cited by
- 39
- References
- 32
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 22 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 1
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Advances in Skin & Wound Care (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Health Sciences › Health Professions › Occupational Therapy › Pressure Ulcer Prevention and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- pressure ulcer prevention, nutritional support, cost-effectiveness, hospitalized patients, malnutrition, quality-adjusted life years, hospital costs, patient education
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Australia, Cost-Benefit Analysis, Pressure Ulcer, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Primary Prevention, Retrospective Studies, Sex Factors, Cohort Studies, Outcome Assessment, Health Care, Nutritional Support, Risk Assessment, Models, Economic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
