Closed Incisional Negative Pressure Wound Therapy is Cost-Effective at Reducing Superficial Surgical Site Infections

Author(s):
Lauren Kerivan; Terra Hill; Christopher Guidry

Background:

Surgical site infections (SSIs) constitute 16% of all health care-associated infections in the United States alone and are directly attributable to more than US $3.3 billion in costs and over 1 million extra hospital days in affected patients. Recently, evidence has emerged suggesting that prophylactic closed incision negative pressure wound therapy (ciNPWT) may significantly reduce the risk of postoperative wound complications, specifically SSIs. This study aimed to evaluate whether ciNPWT is cost-effective compared to routine incision care for the prevention of superficial SSIs.

Hypothesis:

We hypothesized that ciNPWT is cost-effective compared to routine incision care for the prevention of superficial SSIs.

Methods:

A decision and cost-effectiveness model was created comparing the use and non-use of ciNPWT. Superficial SSI probabilities, cost of care for patients with and without postoperative infection, and quality of life SF-36 survey data were obtained from a literature review. Cost of ciNPWT was obtained from health administrative data. A decision tree was constructed using TreeAge Software Pro Version 2020 (Treeage Software, Inc., Williamstown, MA). Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness and reliability of the model.

Results:

One-way sensitivity analysis with a willingness-to-pay threshold of $50,000 demonstrated that above a baseline infection rate of approximately 5%, ciNPWT is cost-effective at reducing superficial surgical site infection. Probabilistic sensitivity analysis indicated that even with uncertainty present in the variables analyzed, the majority of simulations (96.05%) favored ciNPWT as the more effective strategy.

Conclusions:

Despite the added device cost, ciNPWT is cost-effective for superficial SSI prevention across a variety of surgical infection risk profiles.