Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy.
BACKGROUND
Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness.


OBJECTIVE
To evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial.


METHODS
An economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained.


RESULTS
Patients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates.


CONCLUSIONS
NPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds.
ACTRN12612000171819.
School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Christopher
C
Heard
NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
Wendy
W
Chaboyer
NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
Vinah
V
Anderson
NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
Brigid M
BM
Gillespie
School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia; Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK. Electronic address: Jennifer.Whitty@uea.ac.uk.
Jennifer A
JA
Whitty
D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000191:economics*; D009765:Obesity / Q000150:complications; D010865:Pilot Projects; D049590:Postpartum Period; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*
Caesarean section; Cost-effectiveness analysis; Negative pressure wound therapy; Surgical site infection; Wounds