WOUND Study: A Cost-Utility Analysis of Negative Pressure Wound Therapy After Split-Skin Grafting for Lower Limb Skin Cancer

Abstract

BackgroundSkin cancer rates in New Zealand are estimated to be the highest in the world. Split-skin grafting is a common procedure after skin cancer excision in the lower limb. We sought to evaluate the cost-effectiveness of negative pressure wound therapy (NPWT) with same-day discharge in patients undergoing split-skin grafting of the lower limb for the treatment of skin cancer. Materials and methodsUsing effectiveness and quality of life data from a blinded, randomized single-center trial, a decision analytic model was developed from the perspective of the New Zealand hospital health-care buyer. The patient population included adults aged >18 y undergoing elective removal of lower limb skin cancer who were deemed able to manage a portable negative pressure device at home. A deterministic cost-effectiveness model was constructed using cost and utility data from our single-center Wound outcomes in negative pressure dressing (WOUND) trial. Forty-nine patients were randomized to receive either a negative pressure dressing applied in theater with same-day discharge home or a traditional bolster dressing with 5 d of inpatient bed rest. Patients were followed up for 3 mo to assess the mean percentage of graft take and complications. Quality of life was assessed through a EuroQoL questionnaire at 5-7 d. Cost data were collected directly from hospital records for each patient. Probabilistic sensitivity analysis was used to characterize uncertainty. ResultsCompared with standard dressing, NPWT resulted in an average cost saving of $3903.28 per treatment and a disutility of 0.083. At a willingness-to-pay threshold of 25,000 New Zealand dollars, the incremental net benefit is $1828.27, indicating that NPWT is a cost-effective treatment option. The probability of NPWT being cost-effective was 73.15%. ConclusionsNPWT and same-day discharge in the appropriately selected patient is a cost-effective treatment compared with standard care.