Cost‐effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women: a trial‐based economic evaluation

Objective To evaluate the cost‐effectiveness of incisional negative pressure wound therapy ( iNPWT ) in preventing surgical site infection in obese women after caesarean section. Design A cost‐effectiveness analysis conducted alongside a clinical trial. Setting Five obstetric departments in Denmark. Population Women with a pregestational body mass index ( BMI ) ≥30 kg/m 2 . Method We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT ( n = 432) or a standard dressing ( n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. Main outcome measures Cost‐effectiveness based on incremental cost per surgical site infection avoided and per quality‐adjusted life‐year ( QALY ) gained. Results The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALY s. At a willingness‐to‐pay threshold of €30,000, the probability of the intervention being cost‐effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre‐pregnancy BMI ≥35 kg/m 2 . Conclusion Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre‐pregnancy BMI ≥35 kg/m 2 . Tweetable abstract Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.