The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis
| Autor: | Chris Morrow, Arvind U. Gowda, Karan Chopra, Devinder Singh, Luther H. Holton |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Abdominal Wound Closure Techniques Databases Factual medicine.medical_treatment Cost-Benefit Analysis Treatment outcome 030230 surgery 03 medical and health sciences 0302 clinical medicine Negative-pressure wound therapy medicine Humans Surgical Wound Infection Cost–utility analysis business.industry Decision Trees Abdominal wall reconstruction United States Surgery Quality-adjusted life year Abdominal incision Treatment Outcome 030220 oncology & carcinogenesis Quality-Adjusted Life Years business Negative-Pressure Wound Therapy |
| Zdroj: | Plastic and reconstructive surgery. 137(4) |
| ISSN: | 1529-4242 |
| Popis: | 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.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.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.The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients. |
| Databáze: | OpenAIRE |
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