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A Cost-Utility Analysis of the Use of -125mmHg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery
Joshua A. Bloom MD
1, Carly Wareham MD
2, Dhruv Singhal MD
1, Samuel J. Lin MD MBA
1, Bernard T. Lee MD MBA MPH
1, Salvatore Nardello DO
4, Christopher Homsy MD
3, Sarah M. Persing MD MPH
3,
4, Abhishek Chatterjee MD MBA FACS
3,
4
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 2Department of Surgery, Tufts Medical Center, Boston, MA, 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA, 4Division of Surgical Oncology and Breast Surgery, Department of Surgery, Tufts Medical Center, Boston, MA
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 vs. 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 (ICUR) 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 ICUR 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 $1,347.02 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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