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Cost-Effectiveness Comparison Between Topical Silver Sulfadiazine and Enclosed Silver Dressing for Partial-Thickness Burn Treatment

Sheckter, Clifford C. MD*; Van Vliet, Michael M. MD*; Krishnan, Naveen M. BS, MPhil; Garner, Warren L. MD*

doi: 10.1097/BCR.0b013e3182a36916
Original Articles

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.

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.

Warren Garner, MD, is part of the Physician Advisory Panel for Molnlycke Health Care, where he meets once a year regarding new product acquisition. Per his affiliations with the Los Angeles County Medical Center and the University of Southern California, he does not receive compensation promoting product use. The other authors declare no conflict of interest.

Address correspondence to Warren L. Garner, MD, Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, 1500 San Pablo St, Los Angeles, CA 90033.

© 2014 The American Burn Association