title: Cost analysis of negative-pressure wound therapy with instillation for wound bed preparation preceding split-thickness skin grafts for massive (>100 cm(2)) chronic venous leg ulcers.
abstract: OBJECTIVE
  Massive (≥100 cm(2)) venous leg ulcers (VLUs) demonstrate very low closure rates with standard compression therapy and are costly to manage. Negative-pressure wound therapy (NPWT), followed by a split-thickness skin graft (STSG), can be a cost-effective alternative to this standard care. We performed a cost analysis of these two treatments.
  
  
  METHODS
  A retrospective review was performed of 10 ulcers treated with surgical debridement, 7 days of inpatient NPWT with topical antiseptic instillation (NPWTi), and STSG, with 4 additional days of inpatient NPWT bolster over the graft. Independent medical cost estimators were used to compare the cost of this treatment protocol with standard outpatient compression therapy.
  
  
  RESULTS
  The average length of time ulcers were present before patients entered the study was 38 months (range, 3-120 months). Eight of 10 patients had complete VLU closure by 6 months after NPWTi with STSG. The 6-month costs of the proposed treatment protocol and standard twice-weekly compression therapy were estimated to be $27,000 and $28,000, respectively.
  
  
  CONCLUSIONS
  NPWTi with STSG treatment is more effective for closure of massive VLUs at 6 months than that reported for standard compression therapy. Further, the cost of the proposed treatment protocol is comparable with standard compression therapy.
authors.affiliation: Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: C Kevin
authors.initials: CK
authors.lastname: Yang
authors.affiliation: Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Sean
authors.initials: S
authors.lastname: Alcantara
authors.affiliation: Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Selena
authors.initials: S
authors.lastname: Goss
authors.affiliation: Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY. Electronic address: jlantis@chpnet.org.
authors.forename: John C
authors.initials: JC
authors.lastname: Lantis
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000191:economics; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003646:Debridement / Q000191:economics; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000191:economics*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000191:economics*; D007507:Therapeutic Irrigation / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000191:economics* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014945:Wound Healing
chemical_list: D000891:Anti-Infective Agents, Local