NEGATIVE-PRESSURE WOUND THERAPY (NPWT) EQUIPMENT IN THE MANAGEMENT OF OPEN ABDOMEN PATIENTS: COMPARISON BETWEEN TWO PAYMENT SCHEMES

Purpose:

Analyze what the best Negative-Pressure Wound Therapy (NPWT) equipment payment scheme would be for Instituto Mexicano del Seguro Social

Method:

Negative-pressure wound therapy is both an effective and safe therapy to manage patients suffering from complicated intra-abdominal infection or severe abdominal trauma. Payment scheme called Zero inventory "fixed kit" includes negative pressure wound equipment on lease and a weekly fixed-amount supplies kit (2,255 dlls) until the patient is cured. Clinical evidence search was performed via PubMed to know patients average stay (days). IMSS patients stay distribution was analyzed using IMSS Discharges Database. Expert opinion and clinical information about the natural history disease were used to estimate the amount of supplies needed on a weekly basis of the so called "kit by patient". We performed an analysis on cost of “fixed kit” which was compared against the "kit by patient”. Finally, in order to estimate these two therapies savings, the total cost of therapy of IMSS patients in 2014 with both kits –“fixed kit" and "kit by patient"- was compared.

Result:

According to clinical evidence, the median stay of patients with open abdomen is 9 days (4-18), while for the 920 IMSS patients; the median was 10.6 days (3-78) on average. 90% of IMSS patients were 21 days or less under treatment (Figure 1). As patient improves, fewer supplies are needed, so the "fixed kit" scheme cost increases depending on stay extension (Figure 2). Total cost of IMSS patients suffering from open abdomen is higher with the "fixed kit" (Figure 3). Using the "kit by patient" would represent 820,000 dlls on yearly savings, compared to the "fixed kit" (Figure 4).

Conclusion:

The "kit by patient" scheme for negative-pressure wound therapy for open abdomen IMSS patients would generate savings. This type of analysis can be repeated on similar schemes of institution payment schemes.