封闭切口负压疗法对高危腹部切口的经济影响：一项成本-效用分析。
The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.
作者信息
Chopra Karan, Gowda Arvind U, Morrow Chris, Holton Luther, Singh Devinder P
机构信息
Baltimore and Annapolis, Md.
From the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic Surgery, Anne Arundel Medical Center.
出版信息
Plast Reconstr Surg. 2016 Apr;137(4):1284-1289. doi: 10.1097/PRS.0000000000002024.
BACKGROUND
Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients.
METHODS
Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results.
RESULTS
The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent.
CONCLUSION
The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.
背景
复杂腹壁重建术术后并发症困扰。最近一项比较封闭式切口负压疗法与标准敷料使用情况的荟萃分析发现，手术部位感染率有统计学意义的降低。封闭式切口负压疗法在该人群中的应用正逐渐得到认可；然而，这种创新敷料的经济影响仍不明确。在本研究中，进行了一项成本效用分析，评估高危患者腹部切口闭合后使用封闭式切口负压疗法和标准敷料的情况。
方法
成本效用方法包括查阅腹壁手术中与封闭式切口负压疗法相关的文献，获取效用估计值以计算成功手术和并发手术部位感染的手术的质量调整生命年得分，使用医疗保险现行程序术语代码汇总成本，并创建决策树以阐明最具成本效益的敷料策略。进行单向敏感性分析以评估结果的稳健性。
结果
上述比较封闭式切口负压疗法与标准敷料的荟萃分析包括五项研究的子集，评估了829例患者的腹壁手术（260例使用封闭式切口负压疗法，569例使用标准敷料）。决策树分析显示，与标准敷料相比，封闭式切口负压疗法估计节省1546.52美元，质量调整生命年增加0.0024；因此，封闭式切口负压疗法是一种占优治疗策略。单向敏感性分析显示，当手术部位感染率大于16.39%时，封闭式切口负压疗法是一种具有成本效益的选择。
结论
在高危患者腹部切口闭合后使用封闭式切口负压疗法可节省成本。
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