Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy

Heard, C. R. C.; Chaboyer, Wendy; Anderson, Vinah; Gillespie, Brigid M.; Whitty, Jennifer A.

doi:10.1016/j.jtv.2016.06.001

Cited by 42 publications

(53 citation statements)

References 26 publications

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“…The five included studies focused on selection of postoperative wound dressings, and compared either negative pressure (vacuum), gauze or film dressings, or wound management protocols using selected dressings. Of the five economic studies, two were conducted in Australia, and one each in Japan, Spain and England ( Table ). These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years.…”

Section: Resultsmentioning

confidence: 99%

“…Of the five economic studies, two were conducted in Australia, and one each in Japan, Spain and England ( Table ). These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years. Two studies were cost‐effectiveness analyses, two were cost–utility analyses and one was a cost–benefit analysis.…”

Section: Resultsmentioning

confidence: 99%

“…These economic evaluations were published between 2000 and 2016, with the majority being published in the past 4 years. Two studies were cost‐effectiveness analyses, two were cost–utility analyses and one was a cost–benefit analysis. Detailed descriptions of the included studies are provided in Table .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Of the five included studies, two were from the perspective of the healthcare provider whereas other three did not explicitly state the study perspective. The costs of interventions were reported in different ways, such as mean cost per patient or patient episode, cost of managing a hypothetical cohort of 1000 surgical patients and cost of each arm of care. Cost included the costs of device and dressings, cost of nursing/staff time, cost of hospital care and care after discharge, cost of treating superficial SSIs and cost of treating deep/organ SSI.…”

Section: Resultsmentioning

confidence: 99%

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Economic case for intraoperative interventions to prevent surgical-site infection

Gillespie

Chaboyer

Erichsen-Andersson

et al. 2017

British Journal of Surgery

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Background: Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting. Methods:The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists.Results: Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality. Conclusion:With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Economic case for intraoperative interventions to prevent surgical-site infection

Gillespie

Chaboyer

Erichsen-Andersson

et al. 2017

British Journal of Surgery

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Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

et al. 2018

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IMPORTANCE Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. OBJECTIVE To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. DATA SOURCES The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. STUDY SELECTION Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. MAIN OUTCOMES AND MEASURES The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. RESULTS Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). CONCLUSIONS AND RELEVANCE Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

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Negative pressure wound therapy for surgical wounds healing by primary closure

Webster

Liu

Norman

et al. 2019

Cochrane Database of Systematic Reviews

132

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Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy

Cited by 42 publications

References 26 publications

Economic case for intraoperative interventions to prevent surgical-site infection

Economic case for intraoperative interventions to prevent surgical-site infection

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

Negative pressure wound therapy for surgical wounds healing by primary closure

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