title: Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment.
abstract: BACKGROUND
  Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost-utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft.
  
  
  METHODS
  A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions.
  
  
  RESULTS
  Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  In our cost-utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chatterjee
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: David
authors.initials: D
authors.lastname: Macarios
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Leah
authors.initials: L
authors.lastname: Griffin
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kosowski
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Pyfer
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Anaeze C
authors.initials: AC
authors.lastname: Offodile
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Daniel
authors.initials: D
authors.lastname: Driscoll
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: Sirish
authors.initials: S
authors.lastname: Maddali
authors.affiliation: Department of Surgery, Tufts Medical Center, Boston, Mass.; Acelity, San Antonio, Tex.; Bassin Center for Plastic Surgery, Tampa, Fla; Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, N.H.; The Lahey Clinic, Burlington, Mass.; and Plastic and Hand Surgical Associates, Portland, Maine.
authors.forename: John
authors.initials: J
authors.lastname: Attwood