Pressure Ulcers |
| The Benefits and Costs of New Therapies
(Diapulse) |
The Journal Of The American Medical Association
June 2, 1993, Volume 269
To the Editor
The article by Ferrell et al’ describing a randomized
trial of low-air-loss beds for treatment of pressure ulcers
was well designed, but the conclusion lacks some up-to-date
information. The authors appear satisfied with improved healing
of the pressure ulcers in the trial and dis cuss the value of
these beds in restoring comfort and quality of life for nursing
home residents. They admit, however, that they did not consider
the economics of widespread use of low-air-loss bed technology.
Apparently, they were not aware of the study by Itoh et al,2
or they would have learned that pressure ulcers are being completely
healed - and at substantial economic savings.
The study by Itoh et al, conducted at the New York University
service at Goldwater Memorial Hospital, New York, evaluated
the effect of Diapulse (pulsed high-frequency, high-peak power
electromagnetic energy; Diapulse Corporation, Great Neck , NY)
in healing of pressure ulcers. Included were nine patients with
stage II ulcers with a mean size of 5.66 cm (range, 1.0 to 15.0
cm) unhealed within 3 to 12 weeks (mean, 8.22 weeks) and 13
patients with stage III ulcers with a mean size of 8.78 cm (range,
0.15 to 40.0 cm) unhealed within 8 to 168 weeks (mean, 34.62
weeks) by conventional methods (including some specialty beds).
When Diapulse was added to conventional treatment, all stage
II ulcers healed within I to 6 weeks (mean, 2.33 weeks), and
all stage III ulcers healed within I to 22 weeks (mean. 8.85
weeks). Observation showed rapid change in appearance of all
ulcers within 24 to 48 hours after commencement of Diapulse
treatment.
The cost analysis revealed a savings of $1115 per stage II ulcer
and $5017 per stage III ulcer, a significant economic factor
accompanied by improved patient care. This information caught
the eye of Mayer,3 who published an actuarial report for the
Association of Life Insurance Medical Directors of America.
He estimates that by applying a "$4500 savings per ulcer
to the estimated prevalence of nursing home residents, the annual
US savings are approximately $2.25 billion. These savings do
not reflect ancillary savings that would derive from reduced
mortality and morbidity. In the latter case, more than 50000
lower extremity amputations are performed on diabetics each
year at an estimated cost of $500 million as a result of chronic
non-healing wounds."
Melvin J. Breite, MD
Bayside, NY
I. Ferrell BA. Osterweil 0, Christenson P. A randomized trial
of low-air-loss beds for treatment of pressure ulcers. JAMA.
199.3;269:494-497.
2. Itoh M, Montemayor JS, Maisumoto E, Eason A. Lee HML, Folk
FS. Accelerated wound healing of pressure ulcers by pulsed high
peak power electromagnetic energy (Diapulse). Derobitns. 1991:4:24-34.
3. Mayer R. An actuarial report on the cost effectiveness of
a new medical technology. J lo.sur Med. 1991:23:120-123. |
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