Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 specialists were familiar with this technology and 2 specialists have used the technology before.

Level of innovation

All specialists agreed that Prevena was an innovative device but that its design was based on other topical negative pressure devices such as traditional vacuum-assisted closure therapy. All specialists noted that there are other negative pressure wound therapy devices available for use in the NHS, 2 specialists mentioned the PICO device. Two specialists stated that Prevena was better than PICO because it uses a higher negative pressure (75 mmHg compared with 125 mmHg) and has a thick foam dressing.

Potential patient impact

All specialists agreed that using Prevena could lead to reduced surgical site infection, incision wound reopening and length of stay. The specialists also noted that using Prevena may need a less frequent treatment pattern than standard care. For example, surgical incisions with standard care dressings would need changing and cleaning every day. People with diabetes, obesity and renal failure are at high risk of surgical site complications; as are people having complicated or repeated surgery or surgery that involves a bacteria colonised area of the body, such as the gut. People at high risk of surgical site complications are likely to benefit the most from Prevena.

Potential system impact

All specialists agreed that using Prevena would likely lead to cost savings because of reduced need for daily dressing changes and reduced surgical site complications. Two specialists advised that daily dressing changes are very costly to the NHS and 1 noted that major surgical site complications after laparotomy are likely to cost at least £10,000 per person. The specialists also noted potential reductions in the amount of time a patient needs to stay in hospital, follow-up procedures and antibiotic use that are likely to lead to cost savings. One specialist thought using Prevena could be cost saving, but felt that further evidence in specific subgroups would be needed to confirm this.

Two specialist stated that a small amount of training is needed to use Prevena. This training would apply to both surgeons and nurses because Prevena is applied by the surgeon and removed 7 days later by nursing staff.

General comments

One specialist stated that generally Prevena was easy to use but that occasionally there would be problems with achieving and maintaining the airtight seal over the wound. The specialist noted that in these cases, a colleague with more extensive training would be needed to help.

One specialist noted that since using Prevena, surgical site infection rates following laparotomy had halved. They noted that the sample size for these data were small (50 people) and that there was a need for better data collection on outcomes with Prevena. One specialist noted that the heterogeneous study populations included in the evidence for Prevena made it difficult to make general recommendations about the technology.