Cost analysis of negative-pressure wound therapy versus standard treatment of acute conflict-related extremity wounds within a randomized controlled trial

Andreas Älgå,Jenny Löfgren,Rawand Haweizy,Sidney Wong,Jonas Malmstedt,Johan Von Schreeb,Birger C Forsberg,Khaldoon Bashaireh

doi:10.1186/s13017-022-00415-1

Abstract

BackgroundClinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflict-related extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds.MethodsWe derived outcome data from a randomized, controlled superiority trial that enrolled adult (≥ 18 years) patients with acute (≤ 72 h) conflict-related extremity wounds at two civilian hospitals in Jordan and Iraq. Primary endpoint was mean treatment-related healthcare costs (adjusted to 2019 US dollars).ResultsPatients were enrolled from June 9, 2015, to October 24, 2018. A total of 165 patients (155 men [93.9%]; 10 women [6.1%]; and median [IQR] age, 28 [21–34] years) were included in the analysis. The cost per patient treated with NPWT was $142 above that of standard treatment. Overall, results were robust in a sensitivity analysis.ConclusionsWith similar clinical outcomes compared to standard care, our results do not support the use of NPWT in routine treatment of conflict-related extremity wounds at civilian hospitals in resource scarce settings.Trial registration NCT02444598.

Highlights

Extremity wounds and fractures constitute the majority of injuries sustained by civilians during armed conflict [1]
Participants were randomly assigned to negative-pressure wound therapy (NPWT) (n = 83), involving a commercial NPWT device with a continuous negative pressure of 125 mm Hg, or standard treatment (n = 82), involving wound dressings with non-adhesive sterile gauze covered with a bandage
The cost per day spent at the hospital was $116 and $109 in the NPWT and standard treatment groups, respectively

Summary

Introduction

Extremity wounds and fractures constitute the majority of injuries sustained by civilians during armed conflict [1]. The management of conflict-related injuries is complex and associated with significant challenges [2, 3]. The resources for healthcare are often limited due to a high burden of disease and injury, and low health. In a randomized controlled trial, we compared NPWT and standard treatment of conflict-related extremity wounds [7]. The clinical outcomes of the trial have been published in full elsewhere [8]. Clinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflictrelated extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds

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