title: Cost-effectiveness comparison between topical silver sulfadiazine and enclosed silver dressing for partial-thickness burn treatment.
abstract: The standard treatment of partial-thickness burns includes topical silver products such as silver sulfadiazine (SSD) cream and enclosed dressings including silver-impregnated foam (Mepilex Ag; Molnlycke Health Care, Gothenburg, Sweden) and silver-laden sheets (Aquacel Ag; ConvaTec, Skillman, NJ). The current state of health care is limited by resources, with an emphasis on evidence-based outcomes and cost-effective treatments. This study includes a decision analysis with an incremental cost-utility ratio comparing enclosed silver dressings with SSD in partial-thickness burn patients with TBSA less than 20%. A comprehensive literature review was conducted to identify clinically relevant health states in partial-thickness burn patients. These health states include successful healing, infection, and noninfected delayed healing requiring either surgery or conservative management. The probabilities of these health states were combined with Medicare CPT reimbursement codes (cost) and patient-derived utilities to fit into the decision model. Utilities were obtained using a visual analog scale during patient interviews. Expected cost and quality-adjusted life years (QALYs) were calculated using the roll-back method. The incremental cost-utility ratio for enclosed silver dressing relative to SSD was $40,167.99/QALY. One-way sensitivity analysis of complication rates confirmed robustness of the model. Assuming a maximum willingness to pay $50,000/QALY, the complication rate for SSD must be 22% or higher for enclosed silver dressing to be cost effective. By varying complication rates for SSD and enclosed silver dressings, the two-way sensitivity analysis demonstrated the cost effectiveness of using enclosed silver dressing at the majority of complication rates for both treatment modalities. Enclosed silver dressings are a cost-effective means of treating partial thickness burns.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles; and †Division of Plastic and Reconstructive Surgery, Geisel School of Medicine, Dartmouth, Hanover, New Hampshire.
authors.forename: Clifford C
authors.initials: CC
authors.lastname: Sheckter
authors.forename: Michael M
authors.initials: MM
authors.lastname: Van Vliet
authors.forename: Naveen M
authors.initials: NM
authors.lastname: Krishnan
authors.forename: Warren L
authors.initials: WL
authors.lastname: Garner
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000191:economics* / Q000627:therapeutic use; D001458:Bandages / Q000191:economics*; D002056:Burns / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D019057:Quality-Adjusted Life Years; D018030:Silver Compounds / Q000191:economics* / Q000627:therapeutic use; D012837:Silver Sulfadiazine / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000891:Anti-Infective Agents, Local; D018030:Silver Compounds; D012837:Silver Sulfadiazine