Delhougne Gary, Hogan Christopher, Tarka Kim, Nair Sunitha
Smith & Nephew, Inc, Fort Worth, TX.
Direct Research LLC, Vienna, VA.
Ostomy Wound Manage. 2018 Jan;64(1):26-33.
Traditional negative pressure wound therapy (NPWT) systems are considered durable. The pump is designed for use by numerous patients over a period of several years. Recently developed smaller, disposable devices are designed for single-patient use. A retrospective analysis of 2012-2014 national Medicare claims data was used to examine payments associated with the use of traditional and disposable NPWT systems. Data extracted included NPWT episodes from the Limited Data Set Standard Analytic Files including the 5% sample for traditional NPWT and 100% sample for disposable NPWT. NPWT episodes were identified using claim service dates and billing codes. Mean costs per episode were compared and analyzed using chi-squared tests for comparisons between patients who received traditional and those who used disposable NPWT. For continuous variables, statistical significance was assessed using Mann-Whitney U tests. The data included traditional (n = 2938; mean age 66.6 years) and disposable (n = 3522; mean age 67.6 years) episodes for the 2 NPWT groups. Wound types differed for NPWT groups (P <.0001) and included surgical (1134 [39%] versus 764 [22%]), generic open (850 [29%] versus 342 [10%]), skin ulcers (561 [19%] versus 1301 [37%]), diabetic ulcers (240 [8%] versus 342 [10%]), and circulatory system wounds (105 [4%] versus 563 [16%]). Average payment amounts were $4650 ± $2782 for traditional and $1532 ± $1767 per disposable NPWT episode (P <.0001). Payment differences were not affected by wound or comorbidity characteristics. Using the 2016 rates, average payments were $3501 for traditional and $1564 for disposable NPWT. Considering the rate of NPWT use in the United States and the results of this study suggesting substantial potential cost savings, additional analyses and cost-effectiveness studies are warranted.
传统的负压伤口治疗（NPWT）系统被认为是耐用的。该泵设计供众多患者在数年时间内使用。最近开发的更小的一次性设备则设计用于单患者使用。对2012 - 2014年全国医疗保险索赔数据进行回顾性分析，以检查与使用传统和一次性NPWT系统相关的费用。提取的数据包括来自有限数据集标准分析文件中的NPWT治疗周期，其中传统NPWT为5%样本，一次性NPWT为100%样本。使用索赔服务日期和计费代码来识别NPWT治疗周期。使用卡方检验比较和分析接受传统NPWT治疗的患者与使用一次性NPWT治疗的患者之间每个治疗周期的平均费用。对于连续变量，使用曼 - 惠特尼U检验评估统计学显著性。数据包括两个NPWT组的传统治疗周期（n = 2938；平均年龄66.6岁）和一次性治疗周期（n = 3522；平均年龄67.6岁）。NPWT组的伤口类型不同（P <.0001），包括手术伤口（1134例[39%]对764例[22%]）、普通开放性伤口（850例[29%]对342例[10%]）、皮肤溃疡（561例[19%]对1301例[37%]）、糖尿病溃疡（240例[8%]对342例[10%]）以及循环系统伤口（105例[4%]对563例[16%]）。传统NPWT每个治疗周期的平均支付金额为$4650 ± $2782，一次性NPWT每个治疗周期为$1532 ± $1767（P <.0001）。支付差异不受伤口或合并症特征的影响。按照2016年的费率，传统NPWT的平均支付金额为$3501，一次性NPWT为$1564。考虑到美国NPWT的使用频率以及本研究结果表明存在大幅节省潜在成本的可能性，有必要进行进一步的分析和成本效益研究。
