WOLLF trial collaborators (Including: Petrou, Stavros, Parker, Benjamin A., Masters, James P. M., Achten, Juul, Bruce, Julie, Lamb, S. E. (Sallie E.), Parsons, Nicholas R. and Costa, Matthew L.). (2019) Cost-effectiveness of negative pressure wound therapy in adults with severe open fractures of the lower limb : evidence from the WOLLF randomised controlled trial. Bone & Joint Journal, 101-B (11). pp. 1392-1401. doi:10.1302/0301-620X.101B11.BJJ-2018-1228.R2

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Abstract

Aims
The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb.

Patients and Methods
An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation.

Results
The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses.

Conclusion
This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Wounds and injuries , Wounds and injuries -- Surgery, Wounds and injuries -- Treatment, Wound healing
Journal or Publication Title:	Bone & Joint Journal
Publisher:	British Editorial Society of Bone and Joint Surgery
ISSN:	2049-4394
Official Date:	1 November 2019
Dates:	Date Event 1 November 2019 Published 3 July 2019 Accepted
Date of first compliant deposit:	4 July 2019
Volume:	101-B
Number:	11
Page Range:	pp. 1392-1401
DOI:	10.1302/0301-620X.101B11.BJJ-2018-1228.R2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Copyright Holders:	©2019 The British Editorial Society of Bone & Joint Surgery
Related URLs:	Publisher

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