Cost-Effectiveness of Closed Incision Negative Pressure Therapy for Surgical Site Management After Revision Total Knee Arthroplasty: Secondary Analysis of a Randomized Clinical Trial

Background: The PROMISES (Post-market, Randomized, Open-Label, Multicenter, Study to Evaluate the Effectiveness of Closed Incision Negative Pressure Therapy Versus Standard of Care Dressings in Reducing Surgical Site Complications in Subjects With Revision of a Failed Total Knee Arthroplasty) randomized controlled trial compared closed incision negative pressure therapy (ciNPT) to standard of care (SOC) after revision total knee arthroplasty in high-risk patients. We assessed the costs associated with 90-day surgical site complications (SSCs) to determine the cost-benefit of ciNPT. Methods: A health economic model was used to determine mean per-patient costs to manage the surgical site, including the costs of postoperative dressings, surgical and non-surgical interventions, and readmission. A subanalysis was performed to examine cost-benefit in lower risk (Charlson Comorbidity Index < 2) and higher risk (Charlson Comorbidity Index >= 2) patients. Results: Patients with ciNPT experienced fewer SSCs (3.4% vs 14.3%; P =.0013) and required fewer surgical (0.7% vs 4.8%; P =.0666) and non-surgical (2.7% vs 12.9%; P =.0017) interventions compared to those with SOC. Readmission rates were significantly higher when patients experienced SSC (31% vs 4%; P =.0001). Using the economic model, respective per-patient costs for the ciNPT ad SOC groups were $666 and $52 for postoperative dressings, $135 and $994 for surgical interventions, $231 and $970 for readmissions, and $15 and $70 for non-surgical interventions. Total per-patient costs for surgical site management were $1,047 for ciNPT and $2,036 for SOC. Among the lower risk population, mean perpatient cost was $1,066 for ciNPT and $1,474 for SOC. Among the higher risk population, mean perpatient cost was $676 for ciNPT and $3,212 for SOC. Conclusion: Despite higher upfront costs for postoperative dressings, ciNPT was cost-effective in this health economic model, decreasing the costs of surgical site management after revision total knee arthroplasty by 49% in this study population and 79% in higher risk subgroup. (C) 2022 The Author(s). Published by Elsevier Inc.

Automated summary

This study evaluated the cost-benefit of closed incision negative pressure therapy (ciNPT) compared to standard of care (SOC) in reducing surgical site complications (SSCs) after revision total knee arthroplasty. The results showed that ciNPT was cost-effective, decreasing the costs of surgical site management by 49% in the study population and 79% in the higher risk subgroup, despite higher upfront costs for postoperative dressings.