A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Abstract

Objective Closed-incision negative pressure therapy (CINPT) with the Prevena 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 CINPT 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 CINPT. Reported utility scores were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure and postoperative 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 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, and to accommodate for the uncertainty in the literature. Results Femoral-popliteal bypass with CINPT is less costly ($40,138 vs $41,774) and more effective (6.14 vs 6.13) compared to without CINPT. This resulted in a negative ICER of −234,764.03, which favored CINPT, indicating a dominant strategy. In one-way sensitivity analysis, surgery without CINPT was more cost-effective if the probability of successful surgery falls below 84.9% or if the cost of CINPT exceeds $3139. Monte Carlo analysis showed a confidence of 99.07% that CINPT is more cost-effective. Conclusions Despite the added device cost of CINPT, it is cost-effective in vascular surgical operations using groin incisions.

Cost Utility of Transcatheter Aortic Valve Replacement: Sapien 3 Versus CoreValve Evolut R

“…Additionally, the QALY difference demonstrated in our study is greater than that of the following published studies, respectively which both showed cost-effectiveness. 15,16 The favorable health effect was largely a result of the outcomes seen in Deharo et al . 9 where S3 was found to be associated with lower mortality, rehospitalization for heart failure, and pacemaker implantation, while stroke and noncardiovascular death was similar between groups.…”

“…Still, this method may be more representative as it takes into account the patient perspective. Second, we utilized a validated visual analog scale to obtain utility scores, 15,16 adapted for interventional cardiology. Third, because this analysis utilized only outcomes evaluated in the Deharo study of over 31,000 patients, it did not include outcomes compared in other studies like paravalvular regurgitation, life-threatening bleeding, and other major vascular complications.…”

“…The perspective of the third-party payer was adopted to provide well-balanced cost burden to each treatment modality, which is a well-accepted and established perspective in the literature. 13–16…”

“…We conducted two forms of sensitivity analyses (SA) to validate our model. 15,16 One-way (deterministic) SA was performed for each variable which was varied from the lowest to the highest values (described in the literature) to assess the impact on our result. The second form of SA was probabilistic SA using Monte Carlo simulation.…”

“…9 These patients were surveyed using a visual analog scale, a validated assessment tool for cost-analysis research (see Supplemental Digital Content for utility survey, http://links.lww.com/ASAIO/ A921). [17][18][19] The health outcomes included successful TAVR surgery, or TAVR with any of the examined outcomes (pacemaker implantation, readmission for heart failure, stroke, and death). Patients were provided with similar clinical scenarios for each of the five health outcomes and asked to mark a value on a "feeling thermometer" ranging from 0 (death) to 100 (perfect health).…”