The duration of therapy varies from a few days to months, depending on the treatment aim and the nature of the wound. NPWT benefits include:
- Rapid wound granulation
- Epithelialisation and contraction
- Reduction of dressing changes
- Reduced infection risk
- Reduced treatment costs
- Control of exudate
- Concurrent rehabilitation
- Better patient tolerance.
Efficacy of NPWT
The efficacy of NPWT was initially described by Morykwas et al and Morykwas. In their pioneering work, Philbeck et alstudied 1032 home healthcare patients with 1170 wounds that failed to respond to previous interventions and were subsequently treated with NPWT. They concluded that NPWT is bothan efficacious and economical treatment modality.
Moues et alexamined the total costs (hospitalisation, nursing, and material) of 54 wounds. The mean was in favour of NPWT. NPWT had significantly higher material expenses, but significantly lower nursing expenses. Schwein et al performed a retrospective analysis of 2288 pressure ulcers (PUs) in home health settings to examine both clinical and economic benefits of NPWT. A matched cohort of 60 NPWT patients showed lower rates of general hospitalisation, wound problems, and emergency admission.
Llanos et alRCT on 60 patients with burns concluded improved skin graft take and shorter hospitalisation with NPWT. Blume et al conducted the largest multicentre randomised controlled trial (RCT) with 342 patients with diabetic foot ulcers (DFUs) comparing NPWT to alginate and hydrogel dressings and concluded that NPWT group had faster healing, reduced secondary amputations, and shorter hospitalisation period (89.5% versus 95.3%).
Trueman pointed that the reduction of unnecessary hospital admissions opened the scope for the use smaller NPWT pumps allowing early patient discharge and management in the community. Potential benefits include freeing up hospital beds, reducing costs, improved patient satisfaction, and reduced hospital readmissions and nosocomial infections.
Meta-analysis is a principal method of cost-effectiveness analysis, however, the heterogeneity of such patients treated with NPWT makes it difficult to compare between different studies. In their systematic review on NPWT, Vikatmaa et alstudied 14 RCTs, which included patients with PUs, posttraumatic wounds, DFUs, and miscellaneous chronic wounds.
They reported that only two trials were classified as high quality studies. In all trials NPWT was at least as effective and in some cases more effective than the control treatment. They concluded NPWT to be a safe treatment, and serious adverse events have been rarely reported. Ubbink et al reviewed NPWT in 13 RCTs and concluded presence of a supportive evidence for the use of NPWT in the treatment of wounds.
Cost effectiveness of NPWT
This study by Driver et al, analysed a cross-section of patients with severe chronic wounds and multiple comorbidities at an outpatient wound clinic, with regard to the cost effectiveness and cost benefit of NPWT (intervention) versus no negative pressure wound therapy (control) at one and two years.
Cost benefit analysis was based on ulcer-free months and cost-effectiveness on quality-adjusted life-years. There were 150 subjects in the intervention group and 154 controls before matching and 103 subjects in each of the matched cohorts.
Time to heal for the intervention cohort was significantly shorter compared to the controls (270 versus 635 days). The intervention cohort had higher benefits and quality-adjusted life-year gains compared to the control cohort at years one and two. By year two, the gains were 68%–73% higher.
In the unmatched cohorts, the incremental net health benefit was R128 657 ($9,933) per ulcer-free month at year two for the intervention, while the incremental cost effectiveness ratio was −825 271 per quality-adjusted life-year gained (undiscounted costs and benefits).
For the matched cohorts, the incremental net health benefits was only R17 757 ($1371) per ulcer-free month for the intervention, but the incremental cost-effectiveness ratio was R4 749 454 ($366 683) per quality-adjusted life-year gained for year two (discounted costs and benefits).
In a patient population with severe chronic wounds and serious comorbidities, NPWT resulted in faster healing wounds and was more cost effective with greater cost benefits than not using negative pressure wound therapy.
Regarding overall cost effectiveness, the intervention was still expensive, but that is the reality amidst limited treatment options for such serious cases of chronic wounds.