Abstract
INTRODUCTION: Healing after a burn injury requires a temporary wound cover until the skin epithelium heals. Traditional wound covering, human cadaver allograft (HCA), is expensive, and limited by availability. OBJECTIVE: To determine if artificial skin substitute (Transcyte) wound cover is cost-effective for temporary wound coverage in patients with major total body surface (TBSA) burns. METHODS: Incremental cost per quality adjusted life year (QALY) in 2000 US dollars is estimated assuming a base case adult patient who has 40% TBSA burn with no inhalation injury, complications, or facial burn followed for one year after HCA or Transcyte procedure. A societal perspective is used. Utilities were surveyed from burn-unit hospital employees. Other variables are taken from literature. RESULTS: Under the base case, Transcyte saves $3600 over HCA, and adds 0.04 QALYs. Quality of life was significantly greater in the Transcyte group (0.54, 95% CI = 0.48–0.59) vs. HCA group (0.65, 95% CI = 0.57–0.74, p = 0.04) while in the hospital, but not significantly different while recovering at home, after recovery, and at work. The incremental QALY of Transcyte minus HCA must be <−0.07 in order for the ICER to reach a threshold of $50,000. Sensitivity analysis shows that a 33% increase in Transcyte price will reach the threshold ICER of $50,000. In addition, this model is highly sensitive to utility at work; a 22% decrease of at-work utility with Transcyte will result in an ICER greater than $50,000. CONCLUSIONS: The results show that use of Transcyte as a temporary wound covering for 40% TBSA burns is a dominant strategy relative to standard HCA. Use of this artificial skin results in cost savings, due to faster healing and less operation room time. A gain in QALYs is seen with Transcyte, due to less scarring and pain during the healing process.
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