Cost-Utility Analysis of Negative Pressure Wound Therapy Compared With Traditional Wound Care in the Treatment of Diabetic Foot Ulcers in Iran

Vahid Alipour, PhD; Aziz Rezapour, PhD; Mehdi Ebrahimi, MD; Jalal Arabloo, PhD


Wounds. 2021;33(2):50-56. 

In This Article


The results of this study indicate that NPWT is less costly and more effective than TWC; thus, it can be considered as a preferred wound management strategy. The results also show that the ICER of NPWT therapy compared with TWC was -$44 370 per QALY; NPWT is a more cost-effective alternative for the treatment of patients with DFU. Varying uncertain parameters (cost and effectiveness) did not change the dominant strategy. In general, NPWT reduces the number of patients who transfer from an infected state to an amputation state, which results in fewer amputations. In addition, the probability of achieving a healed state is higher in NPWT compared with that of TWC; this imposes less costs to both payers and patients.

Well-designed clinical trials have been conducted on the effectiveness of NPWT;[24–27] however, economic evaluation studies comparing cost and clinical effectiveness of NPWT and TWC are limited. Moreover, the results of 2 important studies on economic evaluation of NPWT in comparison to the traditional (ie, saline gas) and advanced treatment options (ie, skin replacement) in patients with DFU indicated that NPWT resulted in a higher QALYs as well as a lower cost.[5,28] The results of the study by Fleck et al[5] showed that QALYs per patient in the NPWT and traditional dressing groups was 0.53 and 0.52, respectively. Meanwhile, the average costs of NPWT and traditional treatment per patient were $57 944 and $79 951, respectively. Therefore, NPWT was more cost-effective, which created more QALYs compared to the traditional treatment.[5] The results of a cohort study by Whitehead et al[16] suggested that NPWT gained 3 more QALY units and €4 million ($4.68 million) fewer costs when compared with advanced wound therapy; therefore, it is considered the more effective wound treatment alternative. In addition, a clinical trial comparing NPWT with traditional treatment showed that the cost of health care providers (as a specialist in wound dressing) per day of NPWT was €81 ($91.84)—traditional treatment cost €176 ($200).[28] This difference was statistically significant, but this study showed that cost of consumables was higher for NPWT vs the comparator. A study conducted by Vaidhya et al[29] suggested that NPWT can be economically considered as a cost-effective alternative compared to saline gas.[29] A systematic review on the cost-effectiveness of NPWT suggested that, despite the fact that many health care providers have the impression that NPWT is more expensive than its alternatives, this technology is actually less costly given the total cost of wound treatment. Based on these findings, the authors conclude that widespread use of this technology in wound management and treatment can reduce costs and improve quality of life for patients.[4] The 1-year time period of this study makes long-term effectiveness and costs untraceable in NPWT. A study over a longer time period that follows the long-term benefits of NPWT, including evaluating reduced rates of amputation and disability, may provide a more complete perspective on this therapeutic option. It is suggested that the use of NPWT in wounds other than DFU be investigated in future studies. Also, the budget impacts of NPWT technology and estimation of its financial burden on health care systems and providers require more research.

These study findings should be interpreted and generalized to settings outside of Iran with caution. The results are influenced by country-specific context such as types and characteristics of health systems reimbursement policies, relative prices, clinical practices, and local costs.[30] It is important to mention that this study can improve the available information on the economic aspects of the field in Iran, with the intention of supporting health professionals and policymakers. Moreover, it can provide adequate information to aid in decision-making on DFU interventions, which may result in providing more cost-effective treatments while managing scarce resources.