A Cost-Utility Analysis of the Use of -125mmHg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery
Carly Wareham1, Joshua Bloom2, Dhruv Singhal2, Samuel Lin2, Bernard Lee2, Jason Hall1, Salvatore Nardello1, Christopher Homsy1, Sarah Persing1, Abhishek Chatterjee1
1. Surgery, Tufts Medical Center, Boston, MA, United States. 2. Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Background: Oncoplastic surgery (OPS) is an accepted breast conservation surgical option for the treatment of breast cancer. Extensive dissection and breast tissue resection provides a lower positive margin rate but also contributes to higher wound complication rates. Closed-incision negative pressure therapy at -125mmHg (cINPT) decreases the rate of wound complications but at a fiscal cost. Our aim was to examine the cost-utility of cINPT in oncoplastic surgery.
Study Design: A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OPS with cINPT or with standard dressing. 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: OPS with contralateral symmetrizing operation and cINPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without cINPT (33.42), and relative cost increase of $667.89. The resulting ICUR of $57432.93/QALY favored cINPT. In one-way sensitivity analyses, 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 cINPT was greater than 8.2%. Monte-Carlo analysis showed a confidence of 75.39% that surgery with cINPT is more cost effective.
Conclusions: Despite the added cost, surgery with cINPT is cost-effective. This finding is a direct result of the decreased overall wound complications with cINPT. These findings support current literature which promotes the use of cINPT in patients with an increased risk of wound complications (diabetes, smoking, etc.) and is the first to show its cost effectiveness in OPS. cINPT should therefore be considered in the oncoplastic population.
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