Division of Plastic and Reconstructive Surgery. Stanford University, Stanford, CA.
Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL.
J Burn Care Res. 2020 May 2;41(3):450-456. doi: 10.1093/jbcr/iraa003.
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.
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.
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.
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.
未行外科切除的部分厚度烧伤采用局部银产品治疗，包括磺胺嘧啶银（SSD）和Mepilex Ag。皮肤同种异体移植物是一种更昂贵的替代物，可作为确定性创面覆盖物，直至自体上皮化。经济限制和向基于价值的护理的转变要求在采用更昂贵的产品之前，对成本和结果进行论证。
使用决策树分析对皮肤同种异体移植物与 SSD 和 Mepilex Ag 进行成本效用分析。基础病例模拟了 20%的体表总面积浅Ⅱ度部分厚度烧伤。效用是根据专家对个人经验的意见得出的。成本是根据 2019 年医疗保险支付得出的。使用回溯法计算质量调整生命年，假设美国的标准预期寿命。进行概率敏感性分析以评估模型的稳健性。
皮肤同种异体移植物与 Mepilex Ag 和 SSD 的增量成本分别为 907.71 美元和 1257.86 美元。同种异体移植物相对于 Mepilex Ag 和 SSD 的增量质量调整生命年（QALY）增益分别为 0.011 和 0.016。这使得同种异体移植物相对于 Mepilex Ag 的增量成本效用比为 84189.29 美元/QALY，而同种异体移植物相对于 SSD 的增量成本效用比为 79684.63 美元/QALY。假设支付意愿阈值为 100000 美元/QALY，概率敏感性分析表明，在 62.1%的情况下，同种异体移植物相对于 Mepilex Ag 具有成本效益，在 64.9%的模拟中相对于 SSD 具有成本效益。
皮肤同种异体移植物与局部银敷料相比，具有更高的 QALY，但成本更高。根据支付意愿阈值，皮肤同种异体移植物可能被认为是治疗部分厚度烧伤的一种具有成本效益的治疗方法。
