Abstract
As part of the development of the National Institute for Health and Care Excellence (NICE) Medical Technologies Guidance on Parafricta Bootees and Undergarments to reduce skin breakdown in people with, or at risk of, pressure ulcers, the manufacturer (APA Parafricta Ltd) submitted clinical and economic evidence, which was critically appraised by an External Assessment Centre (EAC) and subsequently used by the Medical Technologies Advisory Committee (MTAC) to develop recommendations for further research. The University of Birmingham and Brunel University, acting as a consortium, were commissioned to act as the EAC, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC’s findings and the final NICE guidance. Very little comparative evidence was submitted to demonstrate the effectiveness of Parafricta Bootees or Undergarments. The sponsor submitted a simple cost analysis to estimate the costs of using Parafricta in addition to current practice—in comparison with current practice alone—in hospital and community settings separately. The analysis took a National Health Service (NHS) perspective. The basis of the analysis was a previously published comparative study, which showed no statistical difference in average lengths of stay between patients who wore Parafricta Undergarments and Bootees, and those who did not. The economic model incorporated the costs of Parafricta but assumed shorter lengths of stay with Parafricta. The sponsor concluded that Parafricta was cost saving relative to the comparators. The EAC made amendments to the sponsor’s analysis to correct for errors and to reflect alternative assumptions. Parafricta remained cost saving in most analyses, and the savings per prevalent case ranged from £757 in the hospital model to £3455 in the community model. All analyses were severely limited by the available data on effectiveness—in particular, a lack of good-quality comparative studies.
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Author contributions
The EAC report was prepared by Catherine Meads, Subhash Pokhrel and Matthew Glover. Catherine Meads, Subhash Pokhrel and Matthew Glover critically appraised the economic and clinical evidence submitted by the sponsor, and Matthew Glover and Subhash Pokhrel critiqued the submitted cost model. This manuscript was prepared by Catherine Meads, with contributions from Subhash Pokhrel and Matthew Glover. Paul Dimmock provided information and advice on the NICE process, and Mark Campbell provided minimal comments on the abstract. Catherine Meads is the guarantor for the overall content.
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The Birmingham and Brunel Consortium is funded by the National Institute for Health and Care Excellence (NICE) Medical Technologies Evaluation Programme (MTEP) to act as an External Assessment Centre (EAC) for MTEP. This summary of the Medical Technologies Guidance was produced following publication of the final guidance report. This summary has been reviewed by NICE but has not been externally peer reviewed by Applied Health Economics and Health Policy. Catherine Meads, Matthew Glover, Paul Dimmock and Subhash Pokhrel have no conflicts of interest to report.
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Meads, C., Glover, M., Dimmock, P. et al. Parafricta Bootees and Undergarments to Reduce Skin Breakdown in People with or at Risk of Pressure Ulcers: A NICE Medical Technologies Guidance. Appl Health Econ Health Policy 14, 635–646 (2016). https://doi.org/10.1007/s40258-016-0245-2
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DOI: https://doi.org/10.1007/s40258-016-0245-2