title: The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.
abstract: BACKGROUND
  Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients.
  
  
  METHODS
  Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results.
  
  
  RESULTS
  The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent.
  
  
  CONCLUSIONS
  The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.
authors.affiliation: Baltimore and Annapolis, Md.|From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.affiliation: Baltimore and Annapolis, Md.|From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
authors.forename: Arvind U
authors.initials: AU
authors.lastname: Gowda
authors.affiliation: Baltimore and Annapolis, Md.|From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
authors.forename: Chris
authors.initials: C
authors.lastname: Morrow
authors.affiliation: Baltimore and Annapolis, Md.|From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
authors.forename: Luther
authors.initials: L
authors.lastname: Holton
authors.affiliation: Baltimore and Annapolis, Md.|From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000191:economics*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003663:Decision Trees; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States