The Optimal Treatment for Partial Thickness Burns: A Cost-Utility Analysis of Skin Allograft vs. Topical Silver Dressings

Abstract

Introduction Partial thickness burns not undergoing surgical excision are treated with topical silver products including silver sulfadiazine (SSD) and Mepilex Ag. Skin allograft is a more costly alternative that acts as definitive wound coverage until autogenous epithelialization. Economic constraints and the movement toward value-based care demand cost and outcome justification prior to adopting more costly products. Methods A cost-utility analysis was performed comparing skin allograft to SSD and Mepilex Ag using decision tree analysis. The base case modeled a superficial partial thickness 20% total body surface area burn. Utilities were derived from expert opinion on the basis of personal experience. Costs were derived from 2019 Medicare payments. Quality adjusted life years were calculated using rollback method assuming standard life expectancies in the United States. Probabilistic sensitivity analysis was performed to asses model robustness. Results The incremental costs of skin allograft to Mepilex Ag and SSD were $907.71 and $1257.86, respectively. The incremental quality adjusted life year (QALY) gains from allograft over Mepilex Ag and SSD were 0.011 and 0.016. This yielded an incremental cost-utility ratio for allograft vs. Mepilex Ag of $84,189.29/QALY compared with an incremental cost-utility ratio of $79,684.63/QALY for allograft vs. SSD. Assuming willingness-to-pay thresholds of $100,000/QALY, probabilistic sensitivity analysis demonstrated that allograft was cost effective to Mepilex Ag in 62.1% of scenarios, and cost effective to SSD in 64.9% of simulations. Conclusion Skin allograft showed greater QALYs compared with topical silver dressings at a higher cost. Depending on willingness-to-pay thresholds, skin allograft may be a considered a cost-effective treatment of partial-thickness burns.

Caracterização clínica e epidemiológica de pacientes internados em um Centro de Referência em Assistência a Queimados no sul do Brasil

“…Ressaltase que existem variados tratamentos tópicos para as queimaduras, ao passo que as condições do serviço hospitalar e os recursos disponíveis na unidade de queimados devem ser levados em conta, a fim de proporcionar o arsenal terapêutico mais adequado conforme a superfície corporal queimada, o local do corpo atingido pela queimadura e a profundidade da lesão. A ciência segue na busca por um tratamento tópico mais eficiente para as queimaduras, o qual deve apresentar, simultaneamente, atividade antimicrobiana, facilidade para aplicação e controle da dor, além de mínimo custo possível (26). Um estudo encontrou que em 60 dias, 7,9% dos pacientes desenvolveram alguma infecção, sendo que 35,8% atingiram a pele e tecidos moles, 24,4% os pulmões, 18,1% a corrente sanguínea e 17,8% o trato urinário (27).…”

Tissue and Cell Donation: Recommendations From an International Consensus Forum

“…In several studies, researchers have demonstrated the superiority of traditional and new-generation allograft compared with products engineered from nonhuman tissue sources. [53][54][55] In other cases, it is impossible to conclude the superiority of a new-generation product that is more expensive than traditional therapeutic alternatives, 56 and health systems must ultimately choose whether to approve the new product.…”

Prevention and management of scarring after thermal injury

“…Cultured epithelial allografts have been used for temporary coverage of acute burns as a bridge to eventual cultured epithelial autografting. Cost-utility analysis suggested that they facilitate healing in partial-thickness burns [78] . Cultured epithelial autografts may speed wound closure when combined with meshed skin grafts [78] .…”

“…Cost-utility analysis suggested that they facilitate healing in partial-thickness burns [78] . Cultured epithelial autografts may speed wound closure when combined with meshed skin grafts [78] . Fibroblasts added to dermal scaffolds may produce ECM proteins and growth factors that improve healing [77,79] .…”