Cost-Effectiveness Analysis of Negative Pressure Wound Therapy to Prevent Surgical Site Infection after Elective Colorectal Surgery.

Background Surgical site infection is common after colorectal surgery and is associated with increased costs. Prophylactic negative pressure wound therapy was previously shown to reduce surgical site infection compared with conventional dressings. However, negative pressure wound therapy application is met with hesitancy due to its additional cost. Objective To determine whether the application of prophylactic negative pressure wound therapy after elective colorectal surgery is cost-effective. Design A cost-effectiveness analysis comparing prophylactic negative pressure wound therapy versus conventional dressing was completed using a Markov microsimulation model. A publicly funded single healthcare payer perspective was adopted across a lifetime horizon. Setting In-hospital elective colorectal surgery. Patients The base case was an age, sex, and comorbidity-standardized patient undergoing open elective colorectal surgery. Intervention Negative pressure wound therapy application postoperatively over closed incisions. Main outcomes The primary outcomes of interest were the number of surgical site infections, total costs, and Quality-adjusted life years gained. Secondary outcomes included emergency room presentation, hospital re-admission, nursing wound care utilization, fascial dehiscence, incisional hernia, and non-surgical site infections-related complications. Results Standardized to 1,000 patients, we found that prophylactic negative pressure wound therapy prevented 51 surgical site infections, 3 fascial dehiscences, 10 incisional hernias, 22 emergency room presentations, and 6 re-admissions to hospital. This resulted in a total cost saving of $17,066 and 92.2 quality-adjusted life years gained ($17.07 and 0.09 quality-adjusted life years gained on average per patient). When the patients' risk of surgical site infections was greater than 3.2%, negative pressure wound therapy was a cost-effective strategy at a willingness to pay of $50,000/quality-adjusted life years. Limitations We did not model for societal perspective, emergent presentations of incarcerated hernias, or complications with hernia repair. The results of this model are reliant on the published negative pressure wound therapy efficacy and may change when further data arises. Conclusion The use of negative pressure wound therapy is the dominant strategy with improved outcomes and reduced costs compared to conventional dressing in patients undergoing colorectal surgery, particularly in at risk patients. See Video Abstract at http://links.lww.com/DCR/B782.