台南市立醫院 外科 游朝慶醫師
在1999年Philbeck等人發表一篇論文1，比較平均4.3平方公分大的髖部壓瘡，以濕紗布填塞和負壓傷口治療的費用比較，結果負壓傷口治療進步較快，平均97天癒合，每位患者平均共花了健保局居家照護Medicare home healthcare14546美元，平均每天花150美元，而對照組則平均用了247天癒合，共花國家23465美元，平均每天花95美元，故負壓傷口治療雖每日使用成本較貴，但總成本卻是較低。原因是治療時間縮短，以及較低的護理成本，如下表
Table 1 : Comparison of Costs: Vacuum Assisted Closure Therapy and Saline Gauze
Plus Pressure Relief Air Bed
|
| Saline Gauze and Pressure Relief Bed (1) | Vacuum Assisted Closure Therapy (2) |
| Wound closure rate (cm2 per day) | 0.09 | 0.23 |
| Days to heal | 247.00 | 97.00 |
| Materials cost per day, $ (US) | 10.00 | 107.46 |
| Nursing cost per day, $ (US) | 85.00 | 42.50 |
| Total cost per day, $ (US) | 95.00 | 149.96 |
| Total cost to treat, $ (US) | 23,465.00 | 14,546.00 |
1.Philbeck TE Jr, Whittington KT, Millsap MH, et al. The clinical and cost-effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage 1999; 45(11):41-50.
2.Ferrell BA, Osterweil D, Christenson PA. A randomized trial of low-air-loss beds for treatment of pressure ulcers. JAMA 1994; 269(4):494-497.
但筆者認為，在台灣這種醫療人力成本不值錢的國家而言，濕紗布填塞應不致於那麼貴。
下表來自獨立之非營利機構的的加拿大醫療科技評估機構專責機構(現已改名為加拿大藥品及醫療科技評估機構(Canada Agency for Drugs and Technologies in Health, CADTH))於2003年針對VAC的治療費用整理，從兩個case series及1個回顧性病歷分析比較VAC和傳統濕紗布填塞，這些研究只指出兩種換要方式的成本差不多，但沒有指出其總效益。
Table 2: Costs of Vacuum Assisted Closure Therapy From Retrospective Chart Review Studies
| Study, year | Herscovici et al., 2003 (3) $US | Luckraz et al., 2003 (4) $US | Phillips and Rao, 2003 (5) $Cdn |
| Costs | V.A.C. therapy:* $103/day (incl. sponges, canisters, nursing time, and dressing changes 3x/wk) Wet-to-dry (from charts): $100/day (incl. dressing changes 3x/day and nursing time) Free tissue transfer: $6,000 (surgical fee only) | V.A.C. therapy: $16,400/patient Sternal rewiring + closed irrigation: $20,000/patient (Components of costs and duration of treatment not stated) | Weekly labour costs (excluding travel): V.A.C. therapy: $135 Saline dressing: $560 Weekly supplies: V.A.C. therapy: $206 Saline dressing: $135 Weekly equipment: V.A.C. therapy: $413 Saline dressing: $0 Weekly total: V.A.C. therapy: $754 Saline dressing: $695 |
(3) Herscovici D, Jr., Sanders RW, Scaduto JM, Infante A, DiPasquale T. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. Journal of Orthopaedic Trauma 17(10):683-8, 2003;-Dec.
(4) Luckraz H, Murphy F, Bryant S, Charman SC, Ritchie AJ. Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. Journal of Thoracic & Cardiovascular Surgery 2003; 125(2):301-305.
(5) Phillips DE, Rao SJ. Negative pressure therapy in the community: Analysis of outcomes. Wound Care in Canada 2003; 2(1):42-45.
以加拿大Ontario 2003年當時的資料來分析
- V.A.C.治療每48小時換一次藥
- 傳統換藥需一天換一到兩次藥
- V.A.C.耗材及租金費用加起來約每天100加幣
- V.A.C.機器成本約20000加幣
- 若購買機器，一年的分攤成本加耗材費用約每天70加幣
- 傳統的敷料成本約每天15加幣
- 護士/造口師每次換藥人力成本每天48-58加幣
- 若租機器：一天的成本為124-129加幣
- 若買機器：一天的成本為94-99加幣
- 傳統一天換兩次藥：一天的成本為120-146加幣，若一天只換一次藥，則成本會比V.A.C.便宜
參考資料
Fisher A, Brady B. Vacuum assisted wound closure therapy. 2003. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA).
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