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Cost-Effective Care For Massive Burns
Pooja S. Yesantharao, MD, MS, Rahim S. Nazerali, MD, MHS, Clifford C. Sheckter, MD, MS.
Stanford University, Palo Alto, CA, USA.
Introduction: Massive burns are challenging to treat surgically due to limited donor skin. Autologous epidermal grafts such as cultured epidermal autografts (CEAs) and spray keratinocyte suspensions are successful strategies for wound closure when donor sites are limited. There are no investigations to date that describe the differential outcomes or costs between these competing strategies. Cost-effectiveness analysis is required to guide payers, hospitals, and policy makers in determinations of care.
Methods: A cost-utility analysis compared CEAs with spray keratinocytes in adult burn patients with
>50% total body surface area deep partial thickness burns. Hybrid Monte Carlo simulation and Markov modeling (Figure) studied cost-utility from the payer perspective. Model utilities were derived from the Vancouver Scar Scale (VSS) with 1 as the best outcome and 0 as the worst outcome. Deterministic and probabilistic sensitivity analyses were performed varying all model parameters.
Results: CEAs achieved successful wound closure in 73% of simulations compared to 88% for spray keratinocytes. Compared to treatment with CEAs, treatment with spray keratinocytes resulted in cost savings of $254,743, with no compromise in overall utility of treatment based on VSS. As such, spray keratinocyte treatment was the dominant strategy. This finding was robust upon sensitivity analyses.
Conclusion: Spray keratinocyte suspensions were a dominant strategy to CEAs (i.e. cost saving without compromising utility). Payers and providers should consider the cost utility of spray keratinocytes as the dominant treatment strategy for massive burn epidermal grafting. CEA manufactures may want to consider cost reductions to be more economically competitive with alternative strategies.
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