Comment on: Negative pressure wound therapy for surgical wounds healing by secondary intention is not cost-effective

Correspondence to: Jinshan Liu (email: liujinshanqijiang@163.com)

Department of Gastrointestinal Surgery

Chongqing Hospital of Jiangsu Province Hospital

Chongqing

401420

China

BJS, https://doi.org/10.1093/bjs/znaf077, published 06 May 2025

After reading with great interest the research article by Saramago et al.1, I was deeply inspired. This study presents a rigorous modelling approach to evaluate the cost-effectiveness of negative pressure wound therapy (NPWT) in the management of surgical wounds healing by secondary intention (SWHSI), offering important insights for both clinical practice and health policy-making. Building on this valuable work, I would like to cautiously propose a potential direction for further exploration, in the hope of contributing some constructive ideas for future research.

While the model design comprehensively incorporated multidimensional parameters such as treatment efficacy, cost, and quality-adjusted life year, it did not address the potential impact of patient adherence on the effectiveness of NPWT. As a treatment modality that relies heavily on device use and sustained patient cooperation, NPWT outcomes may be significantly influenced by adherence levels2,3. Incorporating adherence as a factor in future models may provide a more nuanced understanding of NPWTs value, especially within specific patient populations.

In addition, the study did not assess how the skill level of healthcare personnel might affect the implementation outcomes of NPWT. Professional training and operational support can meaningfully enhance therapeutic efficacy and reduce the incidence of adverse events during device use4. Given that the SWHSI-2 study included multiple centres, introducing variation in nursing practice as a sensitivity parameter could improve the model's applicability to real-world settings.

In summary, the inclusion of real-world variables such as patient adherence and differences in clinical execution may further enhance the explanatory power of future models and the practicality of resulting policy recommendations.