WOUND Study: A Cost-Utility Analysis of Negative Pressure Wound Therapy After Split-Skin Grafting for Lower Limb Skin Cancer.
Background: Skin cancer rates in New Zealand are estimated to be the highest in the world. Split-skin grafting is a common procedure after skin cancer excision in the lower limb. We sought to evaluate the cost-effectiveness of negative pressure wound therapy (NPWT) with same-day discharge in patients undergoing split-skin grafting of the lower limb for the treatment of skin cancer. Materials and
Methods: Using effectiveness and quality of life data from a blinded, randomized single-center trial, a decision analytic model was developed from the perspective of the New Zealand hospital health-care buyer. The patient population included adults aged >18 y undergoing elective removal of lower limb skin cancer who were deemed able to manage a portable negative pressure device at home. A deterministic cost-effectiveness model was constructed using cost and utility data from our single-center Wound outcomes in negative pressure dressing (WOUND) trial. Forty-nine patients were randomized to receive either a negative pressure dressing applied in theater with same-day discharge home or a traditional bolster dressing with 5 d of inpatient bed rest. Patients were followed up for 3 mo to assess the mean percentage of graft take and complications. Quality of life was assessed through a EuroQoL questionnaire at 5-7 d. Cost data were collected directly from hospital records for each patient. Probabilistic sensitivity analysis was used to characterize uncertainty.
Results: Compared with standard dressing, NPWT resulted in an average cost saving of $3903.28 per treatment and a disutility of 0.083. At a willingness-to-pay threshold of 25,000 New Zealand dollars, the incremental net benefit is $1828.27, indicating that NPWT is a cost-effective treatment option. The probability of NPWT being cost-effective was 73.15%.
Conclusions: NPWT and same-day discharge in the appropriately selected patient is a cost-effective treatment compared with standard care.