Cost-effectiveness analysis of single-use negative pressure wound therapy (sNPWT) to reduce surgical site complications (SSC) in hip and knee replacements: an institutional perspective

Objectives: To evaluate the cost-effectiveness of single-use negative pressure wound therapy (sNPWT) compared to standard wound care (SWC) in patients undergoing routine hip and knee replacement.

Methods: A decision-analytic model was developed using clinical outcomes taken from a single-center trial of 220 patients randomized to treatment with sNPWT or SWC.¹ The clinical outcomes used in the economic model were the incidence of surgical site complications (SSC) and hospital inpatient length of stay (LOS). Hospital costs were estimated using Agency for Healthcare Research and Quality, Health Care Utilization Project cost estimates for Diagnostic Related Group 469, Major joint replacement of lower extremity.^2,3 Additionally, patient subgroups with a body mass index (BMI) ≥35 or an American Society of Anesthesiologists (ASA) score ≥3 were analyzed separately due to elevated risks of SSC and extended LOS. The economic perspective taken was that of the hospital. The time horizon for the analysis was 6 weeks. All costs are expressed in 2016 U.S. Dollars.

Results: In the base case analysis the average LOS for a sNPWT patient was 3.8 days with an expected cost of $19,885 while the average LOS for a SWC patient was 4.1 days with an expected cost of $21,345. In the BMI ≥ 35 subgroup the average LOS for a sNPWT patient was 3.8 days with an expected cost of $19,989 versus an average LOS of 9.9 with an expected cost of $51,784 for a SWC patient. In the ASA ≥ 3 subgroup the average LOS for a sNPWT patient was 4.6 days with an expected costs of $23,767 versus an average LOS of 10.5 with an expected cost of $55,190 for a SWC patient.

Conclusions: The results of this economic analysis suggest that the addition of sNPWT to post-operative wound care can be cost saving by reducing SSC and hospital LOS.