A Cost-utility Analysis Of The Use Of Prevena Closed-incision Negative Pressure System In Vascular Surgery Groin Incisions
Joshua Alex Bloom, MD1, Tina Tian, MD1, Christopher Homsy, MD1, Dhruv Singhal, MD2, Payam Salehi, MD, PhD1, Abhishek Chatterjee, MD, MBA1.
1Tufts Medical Center, Boston, MA, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES: The Prevena closed-incision negative pressure therapy (P-CINPT) system has been used and clinically evaluated in high-risk groin incisions to reduce the risk of postoperative complications. We performed a cost-effectiveness analysis evaluating P-CINPT use in femoral-popliteal bypass with prosthetic graft. METHODS: A literature review looking at prospective randomized trials determined the probabilities and outcomes for femoral-popliteal bypass with and without P-CINPT. Reported utility scores were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure and post-operative complications. Medicare current procedure terminology and diagnosis-related group codes were used to assess the costs for a successful surgery and associated complications. A decision analysis tree (Figure 1) was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-effectiveness ratio (ICER) analysis was performed with a willingness to pay at $50,000. Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the results. RESULTS: Femoral-popliteal bypass with P-CINPT is less costly ($40,138 versus $41,774) and more effective (16.72 versus 16.70) compared to without Prevena. This resulted in a negative ICER of -110,979.15, which favored P-CINPT, indicating a dominant strategy. In one-way sensitivity analysis, surgery without Prevena was the more cost-effective strategy if the probability of successful surgery falls below 84.9% or if the cost of Prevena exceeds $3,528. Monte Carlo analysis showed a confidence of 99.4% that P-CINPT is more cost-effective. CONCLUSIONS: Despite the added device cost of the P-CINPT, its use in Vascular Surgery is cost-effective in vascular surgical operations using groin incisions.
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