Cost-Effectiveness Analysis of NPWT for Surgical Wounds Healing by Secondary Intention

Overview

This study evaluated the cost-effectiveness of negative pressure wound therapy (NPWT) compared with standard dressings for surgical wounds healing by secondary intention (SWHSI) using a lifetime economic model. NPWT was associated with higher costs and only marginally higher quality-adjusted life-years (QALYs), with a less than 30% probability of being cost-effective. The findings showed considerable uncertainty and no evidence supporting NPWT as a cost-effective alternative to standard dressings.

Background

Surgical wounds healing by secondary intention (SWHSI) are complex and prevalent, with significant healthcare burdens due to prolonged healing times, frequent infections, and hospital readmissions. Negative pressure wound therapy (NPWT) is increasingly used to promote healing by applying subatmospheric pressure to wounds, theoretically enhancing granulation tissue formation and reducing edema. Despite its growing use, robust evidence on NPWT's clinical and cost-effectiveness for SWHSI remains limited. The SWHSI-2 trial and subsequent economic modeling aimed to address this evidence gap to inform UK healthcare decision-making.

Data Highlights

Key Findings

• NPWT was associated with higher healthcare costs primarily due to additional intervention expenses.
• Marginal improvements in quality-adjusted life-years (QALYs) were observed with NPWT compared to standard dressings, but these were not statistically significant.
• The probability of NPWT being cost-effective was estimated to be less than 30%, indicating low likelihood of economic advantage.
• Considerable uncertainty in results was driven by variability in pooled relative effectiveness from meta-analysis data.
• Scenario analyses confirmed the robustness of findings, consistently showing no cost-effectiveness advantage for NPWT.
• No evidence demonstrated that NPWT reduced time to healing or complications such as infection, readmission, or further surgery.

Clinical Implications

Clinicians should be cautious in adopting NPWT for SWHSI given the lack of clear clinical benefit and higher associated costs. Standard dressings remain the economically preferable option in the UK healthcare setting. Decision-makers should consider the uncertainty and limited evidence supporting NPWT when allocating resources for wound care management.

Conclusion

This comprehensive economic evaluation found no evidence that NPWT is a cost-effective alternative to standard dressings for surgical wounds healing by secondary intention. The results highlight the need for careful consideration of NPWT use given its higher costs and uncertain clinical benefits.

References

1. SWHSI-2 Trial and Economic Evaluation (2023) -- Cost-Effectiveness Analysis of Negative Pressure Wound Therapy for Surgical Wounds Healing by Secondary Intention
2. NICE Guidance (2022) -- Recommendations for Research on NPWT
3. Cochrane Review (2021) -- Clinical Effectiveness of NPWT in SWHSI