Evolving techniques for negative pressure wound therapy and the value of grass roots comparative effectiveness research.

Abstract

160 Background: There is debate over the value of comparative effectiveness research to address national health problems, but less attention has focused on its value to solve smaller questions. We present an example of local, clinician initiated, and unfunded comparative effectiveness research to address problems related to negative pressure wound therapy (NPWT) at our hospital. NPWT was popularized as the VAC (Vacuum Assisted Closure, Kinetic Concepts, Inc., San Antonio, TX) system and became standard treatment for many inpatient wounds. Between 2000 and 2006, VAC was the only form of NPWT at our hospital. When it became apparent that VAC therapy was costly, and painful, clinicians tried an alternative method using wall suction and gauze (GSUC). In 2007 and 2008 a randomized prospective trial showed the techniques were equally effective while GSUC was less painful and less costly. After the trial, we tracked the frequency of VAC and GSUC use, as well as the cost of NPWT. Methods: From 2000 to 2011, 3,184 inpatients required NPWT; demographics, the method of treatment, and associated costs were recorded prospectively. Data from 2000 – 2006, when only VAC was available, was compared to data from 2009 – 2011, when both VAC and GSUC were available. Results: Between 2000 and 2006, all patients (N=1,746) were treated using the standard VAC. After 2008, fewer patients were treated using the VAC compared to GSUC: 21 (2%) vs 907 (98%), p=0.001. Between 2000 and 2006, the daily cost of therapy with VAC was $97.09/patient (SD=2.54). After 2008, the daily cost of therapy with VAC was $101.34/patient (SD=0.80) compared to $4.22/patient (SD=0.80) for GSUC, p=0.001. The average yearly direct cost of NPWT was $217,500 from 2000 – 2006 and then fell to fell to $14,690 per year for the period of 2009 – 2011, p=0.001. Conclusions: The tools of comparative effectiveness research can be scaled down to assess problems facing single institution. When encouraged to take ownership of the research process, clinicians will also take ownership of the results. In this case, a standard method of wound care was abandoned less than a year after an in-house trial showed it was more painful, more expensive, but not more effective than a homegrown method.