Cost-Effectiveness of Prophylactic Single use Negative Pressure Wound Therapy Dressings (sNPWT*) To Reduce Surgical Site Complications (SSC) In Patients after an Off-Pump Coronary Artery Bypass Grafting Procedure (CABG)

Background: Negative pressure wound therapy (NPWT) has been used to promote the healing of acute and chronic wounds and there is growing interest in extending its use to closed surgical incision to prevent wound complications. Our study therefore aimed to estimate the cost-effectiveness of the prophylactic use of sNPWT use in patients after CABG to reduce SSC defined as dehiscence and sternotomy infections. Method: A decision analytic model was developed from the US payer’s perspective. Baseline data on SSC, revision operations, length of stay, and readmissions were obtained from published literature in patients undergoing CABG1,2,3. Effectiveness data for sNPWT was taken from an open label trial RCT conducted in Poland which randomised 80 patients to treatment with either sNPWT or standard care (SC) and followed them for 6 weeks post-surgery4. Cost data (in US$) such as costs for CABG and revisions, rehabilitation, community care were taken from PREMIER database and published cost-effectiveness studies1,2. Results: The RCT reported an increase in wounds that healed without complications 37/40 (92.5%) in the iNPWT compared to 30/40 (75%) patients in the standard care group p=0.03. The model estimated sNPWT resulted in 0.99 complications avoided compared to 0.95 with SC group. The estimated quality adjusted life years were 0.84 and 0.83 QALYs over 6 weeks respectively. The estimated mean cost/patient was $11,773 for sNPWT compared to $11,697 for SC resulting in an estimated ICER of $10,000/QALY. Thus sNPWT is a cost-effective intervention with the ICER falling within acceptable range which is below $50,000/QALY. The results were consistent across a wide range of assumptions regarding the effect of sNPWT compared to SC on complications and costs. Conclusion: This study suggests that for patients undergoing CABG procedure, the prophylactic use of sNPWT can be considered a cost-effective intervention in reducing SSC.