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. 2024 Oct 1;12(10):e6163.
doi: 10.1097/GOX.0000000000006163. eCollection 2024 Oct.

A Cost-Utility Analysis of the Use of -125 mm Hg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery

Joshua A Bloom  1 , Carly Wareham  2 , Elsa Chahine  2 , Dhruv Singhal  1 , Samuel J Lin  1 , Bernard T Lee  1 , Salvatore Nardello  3 , Christopher Homsy  4 , Sarah M Persing  4   3 , Abhishek Chatterjee  4   3
Affiliations

A Cost-Utility Analysis of the Use of -125 mm Hg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery

Joshua A Bloom et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Closed-incision negative pressure therapy (ciNPT) decreases the rate of wound complications in oncoplastic breast surgery (OBS) but at a fiscal cost. Our aim was to examine the cost-utility of ciNPT in OBS.

Methods: A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OBS with ciNPT versus without. Reported utility scores in the literature were used to calculate quality-adjusted life years (QALYs) for each health state. A decision analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost-utility ratio was calculated. Sensitivity analyses were performed.

Results: OBS with ciNPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without (33.42), and relative cost increase of $667.89. The resulting incremental cost-utility ratio of $57432.93/QALY favored ciNPT. In one-way sensitivity analysis, ciNPT was the more cost-effective strategy if the cost of ciNPT was less than $1347.02 or if the probability of wound dehiscence without was greater than 8.2%. Monte Carlo analysis showed a confidence of 75.39% that surgery with ciNPT is more cost effective.

Conclusion: Despite the added cost, surgery with ciNPT is cost-effective. This finding is a direct result of decreased overall wound complications with ciNPT.

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Conflict of interest statement

Dr. Chatterjee is a consultant for 3M and DeRoyal. All the other authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Decision tree. The top green line represents the cost-effective strategy.
Fig. 2.
Fig. 2.
A, One-way sensitivity analysis. At willingness-to-pay (WTP) of $100,000, oncoplastic breast surgery with Prevena remains the more cost-effective strategy if the cost of Prevena is less than $1347.02. B, One-way sensitivity analysis. At WTP of $100,000, oncoplastic breast surgery with Prevena remains the more cost-effective strategy if the probability of wound dehiscence without Prevena is less than 8.2%.
Fig. 3.
Fig. 3.
Tornado diagram (incremental cost-effectiveness ratio) identifying the greatest variable of uncertainty as the cost of Prevena.
Fig. 4.
Fig. 4.
Probabilistic sensitivity analysis Monte Carlo acceptability at WTP $100,000. A confidence of 75.39% that our conclusion, oncoplastic breast surgery with Prevena is the cost-effective strategy.
See this image and copyright information in PMC

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