Cost effective non-surgical treatment of chronic pressure ulcers
Megan Dale, Clinical Scientist, Cedar, Cardiff and Vale Local Health Board
Bill Cox-Martin, Clinical Nurse Specialist, Pressure Ulcer Outreach Service, Salisbury
NHS Foundation Trust
Susan Peirce, Clinical Scientist, Cedar, Cardiff University
Grace Carolan-Rees, Clinical Scientist, Cedar, Cardiff and Vale Local Health Board
Aim
To compare Pressure Ulcer Outreach Service costs with surgical closure, using cost
modelling.
Method
Salisbury’s Pressure Ulcer Outreach Service was a response to long waiting lists for
surgical closure of chronic, severe pressure ulcers. Two staff combine expertise in
seating, pressure relief, and tissue viability. They visit the patients’ homes with the
district nurse to gather information, give treatment advice and plan equipment
modifications.
Cedar created a cost model using Outreach Service data for 93 referrals (Grade 4
ulcers, Jan 2011 - Nov 2012), including:
Outreach Service:
 10.6 months community treatment (£56.77 daily [1])
 outreach staff and travel
 surgery for 27% of patients
 4% recurrence
Surgical arm:
 6 months community treatment while awaiting surgery (£56.77 daily)
 surgery for 100% of patients
 35% recurrence and retreatment [2]
 recurrence and retreatment [2]
Results
The cost model for initial healing shows a small cost saving from the Outreach Service
compared to surgical treatment alone. Including pressure ulcer recurrence (4% versus
35%) increases the cost saving to £8,598 per patient.
One-way sensitivity analysis showed Outreach becomes cost incurring if:

recurrence rates in the surgical treatment arm fall below 2%

community treatment increase to <£137 daily.
Conclusion
A combination of patient-focused scientific, seating and tissue viability expertise, ,
resulted in healing without surgery for 73% of patients and low recurrence rates. It
delivers patient benefits, cost saving and reduced demand for plastic surgery and
hospital beds. If this approach is extended to prevention, then benefits will be even
greater.
1. Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. 2012. Journal
of Wound Care 21 (6): 261-262
2. National Institute for Health and Clinical Excellence. Clinical Guideline 29 Pressure ulcers: The
management of pressure ulcers in primary and secondary care. September 2005
3.