title: Prophylactic use of negative pressure wound therapy after cesarean delivery.
abstract: OBJECTIVE
  To evaluate the economic benefit of prophylactic negative pressure wound therapy on a closed laparotomy incision after cesarean delivery in comparison with standard postoperative dressing.
  
  
  METHODS
  We designed a decision-analytic model from a third-party payer's perspective to determine the cost-benefit of prophylactic application of negative pressure wound therapy compared with standard postoperative dressing on a closed laparotomy incision after cesarean delivery. Our primary outcome measure was the expected value of the cost per strategy. Baseline probabilities and cost assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2014 U.S. dollars.
  
  
  RESULTS
  Under our baseline parameters, standard postoperative dressing was the preferred strategy. Standard postoperative dressing and prophylactic negative pressure wound therapy cost $547 and $804 per strategy, respectively. Sensitivity analyses showed that prophylactic negative pressure wound therapy can be cost-beneficial if it is priced below $192; standard postoperative dressing is the preferred strategy among patients with surgical site infection rate of 14% or less. If surgical site infection rates are greater than 14%, prophylactic negative pressure wound therapy could be cost-beneficial depending on the degree of reduction in surgical site infections. At a surgical site infection rate of 30%, the rate must be reduced by 15% for negative pressure wound therapy to become the preferred strategy. Monte Carlo simulation of 1,000 patients in 1 million trials showed that standard postoperative dressing was the preferred cost-beneficial strategy with a frequency of 85%.
  
  
  CONCLUSIONS
  Our cost-benefit analysis provides economic evidence suggesting that negative pressure wound therapy should not be used on closed laparotomy incisions of patients with low risk of postcesarean delivery surgical site infections. However, among patients with a high risk of surgical site infections, prophylactic negative pressure wound therapy is potentially cost-beneficial.
authors.affiliation: Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, New York; Social Science Research Center, Mississippi State University, Starkville, Mississippi; and the Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Nelson C
authors.initials: NC
authors.lastname: Echebiri
authors.forename: M Maya
authors.initials: MM
authors.lastname: McDoom
authors.forename: Meaghan M
authors.initials: MM
authors.lastname: Aalto
authors.forename: Jessie
authors.initials: J
authors.lastname: Fauntleroy
authors.forename: Nagammai
authors.initials: N
authors.lastname: Nagappan
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Barnabei
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006300:Health Services Misuse / Q000191:economics* / Q000639:trends; D006801:Humans; D018803:Models, Economic; D009010:Monte Carlo Method; D054843:Negative-Pressure Wound Therapy / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*