Cost-minimization Analysis of Negative Pressure Wound Therapy in Long-term Care Facilities

Objective. This study aims to conduct a cost-minimization analysis comparing wound treatment costs between single-use negative pressure wound therapy (sNPWT) and traditional negative pressure wound therapy (tNPWT). Materials and Methods. Assuming comparable outcomes, cost data obtained from the ECRI Institute were compared between the 2 NPWT options using data extracted from an electronic wound management program between August 2010 and March 2016. Results. Use of sNPWT versus tNPWT resulted in daily and total treatment duration cost savings of $55 and $1586, respectively. Conclusions. Long-term care facilities can potentially accrue significant cost savings by using sNPWT instead of tNPWT on a majority of eligible wounds.

As of 2014, $28.1 billion was a conservative estimate of health care costs for the 8.2 million Medicare beneficiaries with ≥ 1 type of wound or wound-related infection in the United States.¹ Evidence supporting superior clinical outcomes of negative pressure wound therapy (NPWT) versus standard of care include promotion of granulation tissue formation, reduced time to wound closure, and increased proportion of wounds that achieve closure for diabetic foot ulcers, venous leg ulcers, and full-thickness wounds.^2-5 Although NPWT can lower costs by reducing treatment duration and health care resource use,^6,7 the cost of prolonged wound care can be significant.

Traditional NPWT (tNPWT) systems use large, reusable electrical pumps to deliver negative pressure while single- use NPWT (sNPWT; PICO; Smith & Nephew, Fort Worth, TX) are portable systems designed for single-use and assumed to have comparable clinical outcomes as tNWPT, with the potential to reduce wound care costs compared with tNPWT.^8-11 To examine this possibility, the authors identified the proportion of wounds on tNPWT amenable to sNPWT based on certain wound characteristics and estimated through a cost-minimization analysis whether the use of sNPWT compared with tNPWT systems could result in cost savings for long-term health care facilities (LCFs)

Identification of wounds amenable to sNPWT 

Using de-identified data between August 2010 and March 2016 from an electronic wound management program (Wound Rounds; Telemedicine Solutions LLC, Schaumburg, IL), the authors identified wounds treated with tNPWT with certain characteristics among patients in LCFs. 

The mean treatment duration of identified tNPWT wounds amenable to sNPWT that had a maximum surface area of 500 cm² (within the 8 dressing sizes of the sNPWT system) and minimal to moderate wound exudate amounts was estimated. This study utilized only aggregated results; thus, ethics committee review and approval were not required.

Cost-minimization analysis

From the institution’s perspective, the most recent, publicly available cost data were used to estimate the daily cost associated with both NPWT treatment options. Cost data for the sNPWT were obtained from the ECRI 2016–2017 Price Guide database¹² and minimum rental cost for tNPWT from 2011 ECRI data adjusted to 2016 US dollars based on the Medical Equipment & Supplies Consumer Price Index from the Bureau of Labor Statistics.^13,14 The ECRI Institute (Plymouth Meeting, PA) is an independent, nonprofit research organization focused on the discovery and publication of the best medical procedures, devices, and medications based on the highest standards of safety, quality, and cost effectiveness, with the overarching aim to benefit patient care.¹⁵ Assuming comparable treatment outcomes, costs between sNPWT and tNPWT were compared. Sensitivity analysis was conducted to account for reductions in tNPWT prices due to the Centers for Medicare and Medicaid Services (CMS) competitive bidding program.¹⁶ A threshold analysis was performed to determine the point at which sNPWT became cost neutral compared with tNPWT.

A total of 1249 (88.3%) wounds treated with tNPWT met inclusion criteria, making them amenable to treatment with the sNPWT device. Mean age ± standard deviation (SD) of these patients was 67.4 ± 14.7 years, and 54% of patients were female. Mean surface area ± SD was 39.2 ± 60.1 cm² and mean wound treatment duration ± SD was 29 ± 21.3 days. By wound type, 84.3% of pressure, 90.1% of trauma, and 92.8% of vascular wounds treated with tNPWT were amenable to sNPWT (Table 1). 

The use of sNPWT versus tNPWT resulted in a daily and total treatment cost savings of $55 and $1586, respectively, for each wound treated (Table 2). Single-use NPWT remained cost saving despite cost variations of tNPWT from 41% below to 41% above the base case cost, with daily cost savings of $19 and $91, respectively, and average total treatment cost savings of $544 and $2629, respectively (Table 2). Threshold analysis demonstrated that sNPWT remained a cost-saving treatment option up to when cost increased to $88 per day from the reported cost of $33 per day.

This study examined potential cost savings associated with sNPWT by identifying wounds amenable to treatment with this device among residents of LCFs where tNPWT had been prescribed. Among residents of LCFs, the investigators found that a majority of wounds (> 88%), regardless of type (pressure, trauma, or vascular), being treated with tNPWT met the criteria that made them amenable to treatment with sNPWT. With an increased emphasis on value- based health care, the utilization of wound treatment options with the potential to yield significant cost savings while maintaining optimal outcomes cannot be overemphasized. The strength of this study lies in the use of real-world wound assessment data, making it possible to assess the proportion of wounds that could be treated with a sNPWT system. 

There are certain limitations to be considered regarding the present study. These include generalizing the study findings beyond the population studied. The uncertainty surrounding the cost estimates used may be considered a potential limitation; however, the investigators conducted a sensitivity analysis to mitigate this. Finally, while there is no evidence to prove otherwise, the assumption of therapeutic equivalence may be considered a limitation. 

There is a significant cost-saving potential associated with the use of sNPWT compared with tNPWT on the majority of wounds.

Affiliation: Smith & Nephew, Inc, Andover, MA

Correspondence: Ayoade Adeyemi, PhD, Smith & Nephew Inc, 150 Minuteman Road, Andover, MA 01810; Ayoade.Adeyemi@smith-nephew.com

Disclosure: This study was funded by Smith & Nephew, Inc. Both authors are paid employees of Smith & Nephew. Joann Hettasch, PhD (Fishawack Communications, Inc, Conshohocken, PA), provided medical writing support.