Gee Kee E, Stockton K, Kimble R M, Cuttle L, McPhail S M
Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia.
Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia.
Burns. 2017 Jun;43(4):724-732. doi: 10.1016/j.burns.2016.09.018. Epub 2017 Apr 10.
Partial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0-15 years using days to full wound re-epithelialization as the health outcome.
This study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures.
Costs (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures.
This economic evaluation has demonstrated that Mepilex Ag™ was the dominant dressing choice over both Acticoat™ and Acticoat™ with Mepitel™ in this trial-based economic evaluation and is recommended for treatment of paediatric partial thickness burns ≤10% TBSA.
儿童全身表面积（TBSA）高达10%的浅度烧伤是常见损伤，主要在门诊使用昂贵的含银敷料进行治疗。然而，缺乏针对儿科烧伤人群的经济评估，以帮助医疗服务提供者选择使用哪种敷料。本研究的目的是以创面完全重新上皮化所需天数作为健康结局，对三种用于0至15岁儿童TBSA≤10%的浅度烧伤的银敷料进行成本效益分析。
本研究是一项从医疗服务提供者角度进行的基于试验的经济评估（增量成本效益分析）。96名儿童参与了一项试验，该试验调查了Acticoat™、搭配Mepitel™的Acticoat™或Mepilex Ag™。在2013年3月至2014年7月的试验期间以及重新上皮化后的一年时间范围内，收集了与TBSA≤10%的浅度烧伤管理直接相关的成本。通过对试验数据进行自助重采样估计增量成本效益比并计算优势概率。进行敏感性分析以检验考虑罕见但成本高昂的皮肤移植手术程序的潜在影响。
与Acticoat™（中位数244.90澳元）和搭配Mepitel™的Acticoat™（中位数196.66澳元）干预措施相比，Mepilex Ag™组的成本（敷料、人工、镇痛药、瘢痕管理）显著更低（中位数94.45澳元）。Mepilex Ag™分别比Acticoat™和搭配Mepitel™的Acticoat™更具优势（更便宜且更有效）的概率为99%和97%。在进行先验调整和敏感性分析后，这种优势模式在原始成本和效果方面都是一致的。在初步分析中，搭配Mepitel™的Acticoat™比Acticoat™更具优势的概率为82%，尽管该概率对皮肤移植手术的效果敏感。
这项经济评估表明，在这项基于试验的经济评估中，Mepilex Ag™是比Acticoat™和搭配Mepitel™的Acticoat™更具优势的敷料选择，推荐用于治疗TBSA≤10%的儿科浅度烧伤。
