Cost analysis of negative-pressure wound therapy versus standard treatment of acute conflict-related extremity wounds within a randomized controlled trial

Andreas Älgå; Jenny Löfgren; Rawand Haweizy; Khaldoon Bashaireh; Sidney Wong; Birger C Forsberg; Johan von Schreeb; Jonas Malmstedt

doi:10.1186/s13017-022-00415-1

Cost analysis of negative-pressure wound therapy versus standard treatment of acute conflict-related extremity wounds within a randomized controlled trial

World J Emerg Surg. 2022 Feb 10;17(1):9. doi: 10.1186/s13017-022-00415-1.

Authors

Andreas Älgå^{1

2}, Jenny Löfgren³, Rawand Haweizy⁴, Khaldoon Bashaireh^{5

6}, Sidney Wong⁷, Birger C Forsberg⁸, Johan von Schreeb⁸, Jonas Malmstedt⁹

Affiliations

¹ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden. andreas.alga@ki.se.
² Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. andreas.alga@ki.se.
³ Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.
⁴ College of Medicine, Hawler Medical University, 40/0112, Erbil, Iraq.
⁵ Department of Special Surgery, Jordan University of Science and Technology, 22110, Irbid, Jordan.
⁶ Medical Faculty, Yarmouk University, Irbid, 21163, Jordan.
⁷ Médecins Sans Frontières, Operational Centre Amsterdam, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands.
⁸ Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
⁹ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden.

Abstract

Background: Clinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflict-related extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds.

Methods: We derived outcome data from a randomized, controlled superiority trial that enrolled adult (≥ 18 years) patients with acute (≤ 72 h) conflict-related extremity wounds at two civilian hospitals in Jordan and Iraq. Primary endpoint was mean treatment-related healthcare costs (adjusted to 2019 US dollars).

Results: Patients were enrolled from June 9, 2015, to October 24, 2018. A total of 165 patients (155 men [93.9%]; 10 women [6.1%]; and median [IQR] age, 28 [21-34] years) were included in the analysis. The cost per patient treated with NPWT was $142 above that of standard treatment. Overall, results were robust in a sensitivity analysis.

Conclusions: With similar clinical outcomes compared to standard care, our results do not support the use of NPWT in routine treatment of conflict-related extremity wounds at civilian hospitals in resource scarce settings. Trial registration NCT02444598.

Keywords: Armed conflict; Cost analysis; Trauma; Wounds.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Extremities
Female
Health Care Costs
Humans
Male
Negative-Pressure Wound Therapy*
Wound Healing

Associated data

ClinicalTrials.gov/NCT02444598