Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women

A trial-based economic evaluation

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Objective: To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. Design: A cost-effectiveness analysis conducted alongside a clinical trial. Setting: Five obstetric departments in Denmark. Population: Women with a pregestational body mass index (BMI) ≥30 kg/m 2 . Method: We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Main outcome measures: Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. Results: The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m 2 . Conclusion: Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m 2 . Tweetable abstract: Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.

OriginalsprogEngelsk
TidsskriftB J O G
Vol/bind126
Udgave nummer5
Sider (fra-til)619-627
ISSN1470-0328
DOI
StatusUdgivet - apr. 2019

Fingeraftryk

Cost-Benefit Analysis
Body Mass Index
Quality-Adjusted Life Years
Hospital Obstetrics and Gynecology Department
Cost Savings
Denmark
Emergencies
Randomized Controlled Trials
Outcome Assessment (Health Care)
Clinical Trials
Databases
Delivery of Health Care
Population

Citer dette

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title = "Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women: A trial-based economic evaluation",
abstract = "Objective: To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. Design: A cost-effectiveness analysis conducted alongside a clinical trial. Setting: Five obstetric departments in Denmark. Population: Women with a pregestational body mass index (BMI) ≥30 kg/m 2 . Method: We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Main outcome measures: Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. Results: The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8{\%}. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m 2 . Conclusion: Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m 2 . Tweetable abstract: Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.",
keywords = "Caesarean section, cost-effectiveness, economic evaluation, incisional negative pressure wound therapy, obesity, quality-adjusted life-years, surgical site infection, Quality-Adjusted Life Years, Surgical Wound Infection/economics, Humans, Cesarean Section/adverse effects, Treatment Outcome, Negative-Pressure Wound Therapy/economics, Bandages/economics, Pregnancy, Pregnancy Complications/surgery, Cost-Benefit Analysis, Standard of Care/economics, Denmark, Adult, Female, Obesity/surgery",
author = "Nana Hyldig and Joergensen, {Jan Stener} and Chunsen Wu and Camilla Bille and Vinter, {Christina Anne} and Sorensen, {Jens Ahm} and Ole Mogensen and Lamont, {Ronald Francis} and S{\"o}ren M{\"o}ller and Marie Kruse",
note = "{\circledC} 2018 Royal College of Obstetricians and Gynaecologists.",
year = "2019",
month = "4",
doi = "10.1111/1471-0528.15573",
language = "English",
volume = "126",
pages = "619--627",
journal = "B J O G",
issn = "1470-0328",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women

T2 - A trial-based economic evaluation

AU - Hyldig, Nana

AU - Joergensen, Jan Stener

AU - Wu, Chunsen

AU - Bille, Camilla

AU - Vinter, Christina Anne

AU - Sorensen, Jens Ahm

AU - Mogensen, Ole

AU - Lamont, Ronald Francis

AU - Möller, Sören

AU - Kruse, Marie

N1 - © 2018 Royal College of Obstetricians and Gynaecologists.

PY - 2019/4

Y1 - 2019/4

N2 - Objective: To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. Design: A cost-effectiveness analysis conducted alongside a clinical trial. Setting: Five obstetric departments in Denmark. Population: Women with a pregestational body mass index (BMI) ≥30 kg/m 2 . Method: We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Main outcome measures: Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. Results: The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m 2 . Conclusion: Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m 2 . Tweetable abstract: Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.

AB - Objective: To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. Design: A cost-effectiveness analysis conducted alongside a clinical trial. Setting: Five obstetric departments in Denmark. Population: Women with a pregestational body mass index (BMI) ≥30 kg/m 2 . Method: We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Main outcome measures: Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. Results: The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m 2 . Conclusion: Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m 2 . Tweetable abstract: Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.

KW - Caesarean section

KW - cost-effectiveness

KW - economic evaluation

KW - incisional negative pressure wound therapy

KW - obesity

KW - quality-adjusted life-years

KW - surgical site infection

KW - Quality-Adjusted Life Years

KW - Surgical Wound Infection/economics

KW - Humans

KW - Cesarean Section/adverse effects

KW - Treatment Outcome

KW - Negative-Pressure Wound Therapy/economics

KW - Bandages/economics

KW - Pregnancy

KW - Pregnancy Complications/surgery

KW - Cost-Benefit Analysis

KW - Standard of Care/economics

KW - Denmark

KW - Adult

KW - Female

KW - Obesity/surgery

U2 - 10.1111/1471-0528.15573

DO - 10.1111/1471-0528.15573

M3 - Journal article

VL - 126

SP - 619

EP - 627

JO - B J O G

JF - B J O G

SN - 1470-0328

IS - 5

ER -