Single-use negative pressure wound therapy reduces costs in closed surgical incisions: UK and US economic evaluation.

OBJECTIVE: Single-use negative pressure wound therapy (sNPWT) following closed surgical incisions has a demonstrable effect in reducing surgical site complications (SSC). However, there is little health economic evidence to support its widespread use. We sought to evaluate the cost-effectiveness of sNPWT compared with standard care in reducing SSCs following closed surgical incisions. METHOD: A decision analytic model was developed to explore the total costs and health outcomes associated with the use of the interventions in patients following vascular, colorectal, cardiothoracic, orthopaedic, C-section and breast surgery from the UK National Health Service (NHS) and US payer perspective over a 12-week time horizon. We modelled complications avoided (surgical site infection (SSI) and dehiscence) using data from a recently published meta-analysis. Cost data were sourced from published literature, NHS reference costs and Centers for Medicare and Medicaid Services. We conducted subgroup analysis of patients with diabetes, an American Society of Anesthesiologists (ASA) score ≥3 and body mass index (BMI) ≥30kg/m2. A sensitivity analysis was also conducted. RESULTS: sNPWT resulted in better clinical outcomes and overall savings of £105 per patient from the UK perspective and $637 per patient from the US perspective. There were more savings when higher-risk patients with diabetes, or a BMI ≥30kg/m2 or an ASA≥3 were considered. We conducted both one-way and probabilistic sensitivity analysis, and the results suggested that this conclusion is robust. CONCLUSION: Our findings suggest that the use of sNPWT following closed surgical incisions saves cost when compared with standard care because of reduced incidence of SSC. Patients at higher risk should be targeted first as they benefit more from sNPWT. This analysis is underpinned by strong and robust clinical evidence from both randomised and observational studies.

Compressing genomic sequence fragments using SlimGene.

With the advent of next generation sequencing technologies, the cost of sequencing whole genomes is poised to go below $1000 per human individual in a few years. As more and more genomes are sequenced, analysis methods are undergoing rapid development, making it tempting to store sequencing data for long periods of time so that the data can be re-analyzed with the latest techniques. The challenging open research problems, huge influx of data, and rapidly improving analysis techniques have created the need to store and transfer very large volumes of data. Compression can be achieved at many levels, including trace level (compressing image data), sequence level (compressing a genomic sequence), and fragment-level (compressing a set of short, redundant fragment reads, along with quality-values on the base-calls). We focus on fragment-level compression, which is the pressing need today. Our article makes two contributions, implemented in a tool, SlimGene. First, we introduce a set of domain specific loss-less compression schemes that achieve over 40× compression of fragments, outperforming bzip2 by over 6×. Including quality values, we show a 5× compression using less running time than bzip2. Second, given the discrepancy between the compression factor obtained with and without quality values, we initiate the study of using "lossy" quality values. Specifically, we show that a lossy quality value quantization results in 14× compression but has minimal impact on downstream applications like SNP calling that use the quality values. Discrepancies between SNP calls made between the lossy and loss-less versions of the data are limited to low coverage areas where even the SNP calls made by the loss-less version are marginal.