Abstract
BackgroundThere is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures.ObjectivesTo estimate the cost-effectiveness of single use negative pressure wound therapy (sNPWT) compared to standard of care in patients following coronary artery bypass grafting surgery (CABG) procedure to reduce surgical site complications (SSC) defined as dehiscence and sternotomy infections.MethodA decision analytic model was developed from the Germany Statutory Health Insurance payer’s perspective over a 12-week time horizon. Baseline data on SSC, revision operations, length of stay, and readmissions were obtained from a prospective observational study of 2621 CABG patients in Germany. Effectiveness data for sNPWT was taken from a randomised open label trial conducted in Poland which randomised 80 patients to treatment with either sNPWT or standard care. Cost data (in Euros) were taken from the relevant diagnostic related groups and published literature.ResultsThe clinical study reported an increase in wounds that healed without complications 37/40 (92.5%) in the sNPWT compared to 30/40 (75%) patients in the SC group p = 0.03. The model estimated sNPWT resulted in 0.989 complications avoided compared to 0.952 and the estimated quality adjusted life years were 0.8904 and 0.8593 per patient compared to standard care. The estimated mean cost per patient was €19,986 for sNPWT compared to €20,572 for SC resulting in cost-saving of €586. The findings were robust to a range of sensitivity analyses.ConclusionThe sNPWT can be considered a cost saving intervention that reduces surgical site complications following CABG surgery compared to standard care. We however recommend that additional economic studies should be conducted as new evidence on the use of sNPWT in CABG patients becomes available to validate the results of this economic analysis.
Highlights
There is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures
The model estimated single use negative pressure wound therapy (sNPWT) resulted in 0.989 complications avoided compared to 0.952 and the estimated quality adjusted life years were 0.8904 and 0. 8593 per patient compared to standard care
We recommend that additional economic studies should be conducted as new evidence on the use of sNPWT in coronary artery bypass grafting surgery (CABG) patients becomes available to validate the results of this economic analysis
Summary
There is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures. There has been advances in infection control practices and wound dressings yet surgical site infections (SSI) remains common in patients undergoing surgery [1,2,3,4]. European Centre for Disease Prevention and Control (ECDC) reports that SSI are among the most common healthcare-associated infections (HAIs) which occur after surgery in the area of the body where the surgery took place. Graf et al [6] estimated the financial loss to a hospital due to deep sternal wound infection following coronary artery by-pass surgery to be $12,482 (€9154) in Germany. In the United Kingdom, attributable median hospital length of stay (LOS) due to SSI for cardiac patients is estimated to be 23 days and the attributable median costs due to SSI are £11,003 ($8517- $15,395) respectively [10]
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