Bloom Joshua A, Wareham Carly, Chahine Elsa, Singhal Dhruv, Lin Samuel J, Lee Bernard T, Nardello Salvatore, Homsy Christopher, Persing Sarah M, Chatterjee Abhishek
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
Department of Surgery, Tufts Medical Center, Boston, Mass.
Plast Reconstr Surg Glob Open. 2024 Oct 1;12(10):e6163. doi: 10.1097/GOX.0000000000006163. eCollection 2024 Oct.
Closed-incision negative pressure therapy (ciNPT) decreases the rate of wound complications in oncoplastic breast surgery (OBS) but at a fiscal cost. Our aim was to examine the cost-utility of ciNPT in OBS.
A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OBS with ciNPT versus without. Reported utility scores in the literature were used to calculate quality-adjusted life years (QALYs) for each health state. A decision analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost-utility ratio was calculated. Sensitivity analyses were performed.
OBS with ciNPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without (33.42), and relative cost increase of $667.89. The resulting incremental cost-utility ratio of $57432.93/QALY favored ciNPT. In one-way sensitivity analysis, ciNPT was the more cost-effective strategy if the cost of ciNPT was less than $1347.02 or if the probability of wound dehiscence without was greater than 8.2%. Monte Carlo analysis showed a confidence of 75.39% that surgery with ciNPT is more cost effective.
Despite the added cost, surgery with ciNPT is cost-effective. This finding is a direct result of decreased overall wound complications with ciNPT.
闭合切口负压治疗（ciNPT）可降低肿瘤整形乳房手术（OBS）中伤口并发症的发生率，但会产生经济成本。我们的目的是研究ciNPT在OBS中的成本效益。
进行文献综述，以获取采用ciNPT与不采用ciNPT的OBS治疗单侧乳腺癌的概率和结果。文献中报道的效用评分用于计算每种健康状态的质量调整生命年（QALY）。构建决策分析树并进行回滚分析，以确定更具成本效益的策略。计算增量成本效益比。进行敏感性分析。
与不采用ciNPT相比，采用ciNPT的OBS具有更高的临床有效性（QALY为33.43，而不采用为33.42），相对成本增加667.89美元。由此得出的增量成本效益比为57432.93美元/QALY，支持采用ciNPT。在单向敏感性分析中，如果ciNPT的成本低于1347.02美元，或者不采用ciNPT时伤口裂开的概率大于8.2%，则ciNPT是更具成本效益的策略。蒙特卡洛分析显示，采用ciNPT进行手术更具成本效益的置信度为75.39%。
尽管成本增加，但采用ciNPT进行手术具有成本效益。这一发现是ciNPT使总体伤口并发症减少的直接结果。
