Haitham W Tuffaha1, Brigid M Gillespie2, Wendy Chaboyer2, Louisa G Gordon3, Paul A Scuffham3. 1. Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Research Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia. Electronic address: haitham.tuffaha@griffith.edu.au. 2. Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Research Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia. 3. Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia.
Abstract
BACKGROUND: Obese women undergoing cesarean section are at increased risk of postoperative infection. There is growing interest in negative pressure wound therapy (NPWT) to prevent closed surgical incision complications including surgical site infection; however, the evidence on the effectiveness and cost-effectiveness of this technology is limited. The objective of this study was to evaluate the cost-effectiveness of NPWT compared with that of standard dressing in preventing surgical site infection in obese women undergoing elective cesarean section based on current evidence and to estimate the value and optimal design of additional research to study this technology. METHODS: The analysis was from the perspective of Queensland Health, Australia, using a decision model. Parameters were obtained from the published literature, a pilot clinical trial, and expert opinion. Monte Carlo simulation was performed to calculate the net monetary benefit, characterize decision uncertainty, and estimate the value of additional research. Comparing the expected monetary benefits and costs of alternative trial sample sizes informed the optimal future study design. RESULTS: The incremental net monetary benefit of NPWT was Australian dollars 70, indicating that NPWT is cost-effective compared with that of standard dressing. The probability of NPWT being cost-effective was 65%. The estimated value of additional research to resolve decision uncertainty would be Australian dollars 2.7 million. The optimal sample size of a future trial investigating the relative effectiveness of NPWT would be 200 patients per arm. CONCLUSIONS: Based on the current evidence, NPWT is cost-effective; however, there is high uncertainty surrounding the decision to adopt this technology. Additional research is worthwhile before implementation.
BACKGROUND:Obesewomen undergoing cesarean section are at increased risk of postoperative infection. There is growing interest in negative pressure wound therapy (NPWT) to prevent closed surgical incision complications including surgical site infection; however, the evidence on the effectiveness and cost-effectiveness of this technology is limited. The objective of this study was to evaluate the cost-effectiveness of NPWT compared with that of standard dressing in preventing surgical site infection in obesewomen undergoing elective cesarean section based on current evidence and to estimate the value and optimal design of additional research to study this technology. METHODS: The analysis was from the perspective of Queensland Health, Australia, using a decision model. Parameters were obtained from the published literature, a pilot clinical trial, and expert opinion. Monte Carlo simulation was performed to calculate the net monetary benefit, characterize decision uncertainty, and estimate the value of additional research. Comparing the expected monetary benefits and costs of alternative trial sample sizes informed the optimal future study design. RESULTS: The incremental net monetary benefit of NPWT was Australian dollars 70, indicating that NPWT is cost-effective compared with that of standard dressing. The probability of NPWT being cost-effective was 65%. The estimated value of additional research to resolve decision uncertainty would be Australian dollars 2.7 million. The optimal sample size of a future trial investigating the relative effectiveness of NPWT would be 200 patients per arm. CONCLUSIONS: Based on the current evidence, NPWT is cost-effective; however, there is high uncertainty surrounding the decision to adopt this technology. Additional research is worthwhile before implementation.
Authors: Lulu Yu; Ryan J Kronen; Laura E Simon; Carolyn R T Stoll; Graham A Colditz; Methodius G Tuuli Journal: Am J Obstet Gynecol Date: 2017-09-23 Impact factor: 8.661
Authors: Michael Engelhardt; Norah A Rashad; Christian Willy; Christian Müller; Christian Bauer; Sebastian Debus; Tino Beck Journal: Int Wound J Date: 2018-03-12 Impact factor: 3.315
Authors: Gill Norman; Chunhu Shi; En Lin Goh; Elizabeth Ma Murphy; Adam Reid; Laura Chiverton; Monica Stankiewicz; Jo C Dumville Journal: Cochrane Database Syst Rev Date: 2022-04-26
Authors: Joan Webster; Zhenmi Liu; Gill Norman; Jo C Dumville; Laura Chiverton; Paul Scuffham; Monica Stankiewicz; Wendy P Chaboyer Journal: Cochrane Database Syst Rev Date: 2019-03-26
Authors: Gill Norman; En Lin Goh; Jo C Dumville; Chunhu Shi; Zhenmi Liu; Laura Chiverton; Monica Stankiewicz; Adam Reid Journal: Cochrane Database Syst Rev Date: 2020-05-01
Authors: Methodius G Tuuli; Jingxia Liu; Alan T N Tita; Sherri Longo; Amanda Trudell; Ebony B Carter; Anthony Shanks; Candice Woolfolk; Aaron B Caughey; David K Warren; Anthony O Odibo; Graham Colditz; George A Macones; Lorie Harper Journal: JAMA Date: 2020-09-22 Impact factor: 56.272
Authors: Gill Norman; En Lin Goh; Jo C Dumville; Chunhu Shi; Zhenmi Liu; Laura Chiverton; Monica Stankiewicz; Adam Reid Journal: Cochrane Database Syst Rev Date: 2020-06-15
Authors: Fleur E E De Vries; Elon D Wallert; Joseph S Solomkin; Benedetta Allegranzi; Matthias Egger; E Patchen Dellinger; Marja A Boermeester Journal: Medicine (Baltimore) Date: 2016-09 Impact factor: 1.889