Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial.

BACKGROUND: Partial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0-15 years using days to full wound re-epithelialization as the health outcome. METHOD: This study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures. RESULTS: Costs (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures. CONCLUSION: This economic evaluation has demonstrated that Mepilex Ag™ was the dominant dressing choice over both Acticoat™ and Acticoat™ with Mepitel™ in this trial-based economic evaluation and is recommended for treatment of paediatric partial thickness burns ≤10% TBSA.

Low cost silicone renal replicas for surgical training - technical note.

OBJECTIVE: The aim of this brief report was to present and evaluate workflow of preparation of lowcost individual silicone replicas of kidneys for laparoscopic training and surgical simulation of difficult nephron sparing surgeries. METHODS: The work flow consists of four steps: 1.Image segmentation; 2.Casting mould designing; 3.Manufacturing of casting mould; 4.Silicone replica casting. To evaluate the cost and time required to execute the presented method, authors prepared 5 silicone models for 5 consecutive patients undergoing laparoscopic kidney tumorectomy due to renal cell cancer. RESULTS: Average times of image segmentation, casting mould design, casting mould printing and pouring of silicon replicas were 94 min, 22 min, 14 h and 30 min, respectively. Average costs of casting mould printing and casting of silicon replica were 14.4$ and 7.4$ respectively. CONCLUSION: The presented technique is simple to perform and beyond basic 3D printer it does not require any other expensive equipment. The final silicone model reproduces shape and elasticity of the living organ and has similar mechanical strength. These properties of silicone replica in combination with the presented technique can be used to prepare other artificial organs, ready for a simulation of treatment.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

OBJECTIVE: To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. METHODS: An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. RESULTS: On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. CONCLUSIONS: This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

A simplified approach for the rehabilitation of an auricular defect: a case report.

BACKGROUND AND AIM: Replacement of missing ear is a challenging task in which extensive array of materials and techniques have been employed. Materials such as silicones and methacrylate acrylic resins have been widely used for auricular prosthesis. This article describes a simplified procedure for fabricating resilient heat-cured acrylic resin auricular prosthesis, retained with a custom-made acrylic bar with ball attachments. CASE DESCRIPTION AND METHODS: A male patient was reported with right ear loss. A modified technique was preferred to fabricate ear prosthesis with resilient heat-cured acrylic resin in which heat-cured acrylic retentive bar was incorporated. FINDINGS AND OUTCOMES: Contrary to silicones, resilient heat-cured acrylic resin was more economical and compatible with acrylic retentive bar and resulted in a more long-lasting auricular prosthesis. CONCLUSION: Resilient heat-cured acrylic resin was proven to be a better alternative in terms of strength and durability. CLINICAL RELEVANCE: This article presents an economical and simplified approach for the fabrication of prosthesis for a missing ear.

An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream.

An open, parallel, randomized, comparative, multicenter study was implemented to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (Mepilex Ag) vs silver sulfadiazine cream (control) in the treatment of partial-thickness thermal burns. Individuals aged 5 years and older with partial-thickness thermal burns (2.5-20% BSA) were randomized into two groups and treated with the trial products for 21 days or until healed, whichever occurred first. Data were obtained and analyzed on cost (direct and indirect), healing rates, pain, comfort, ease of product use, and adverse events. A total of 101 subjects were recruited. There were no significant differences in burn area profiles within the groups. The cost of dressing-related analgesia was lower in the intervention group (P = .03) as was the cost of background analgesia (P = .07). The mean total cost of treatment was $309 vs $513 in the control (P < .001). The average cost-effectiveness per treatment regime was $381 lower in the intervention product, producing an incremental cost-effectiveness ratio of $1688 in favor of the soft silicone foam dressing. Mean healing rates were 71.7 vs 60.8% at final visit, and the number of dressing changes were 2.2 vs 12.4 in the treatment and control groups, respectively. Subjects reported significantly less pain at application (P = .02) and during wear (P = .048) of the Mepilex Ag dressing in the acute stages of wound healing. Clinicians reported the intervention dressing was significantly easier to use (P = .03) and flexible (P = .04). Both treatments were well tolerated; however, the total incidence of adverse events was higher in the control group. The silver-containing soft silicone foam dressing was as effective in the treatment of patients as the standard care (silver sulfadiazine). In addition, the group of patients treated with the soft silicone foam dressing demonstrated decreased pain and lower costs associated with treatment.

Enhancing patient outcomes--reducing the bottom line: the use of antimicrobial soft silicone foam dressing in home health.

According to the Tabor's Medical Dictionary (2005), bioburden is the number of contaminating microorganisms present on an object, such as a wound. Bioburden is a serious concern for wound care clinicians as it has been well-documented that bioburden may delay wound healing, increase pain and result in increased cost of treatment. Symptoms of bioburden include a delay in wound healing, increase in exudate and odor, a red bright wound bed with exuberant granulation tissue that bleeds readily (Sibbald et al., 2006), and persistence or development of necrotic tissue. Silver dressings are increasingly used in wound care to reduce bioburden. Silver provides potent broad-spectrum antimicrobial activity. When placed in contact with organic molecules, such as wound fluid or tissue that contain proteins or a broad spectrum of microorganisms, silver ions react with the microorganisms (Bolton, 2006).

Mepitel: a non-adherent wound dressing with Safetac technology.

OBJECTIVE: Wound pain and tissue trauma are two main considerations of wound management, and appropriate dressing selection plays an important role in both. Traditional dressings may adhere to wounds resulting in significant pain and trauma to new tissue upon removal. The development of primary wound contact materials has provided a unique approach to solving this problem. This article aims to aid clinicians in identifying wound types on which Mepitel, a primary wound contact dressing with Safetac soft silicone adhesive technology, can be used by summarizing the published clinical literature relating to its use. METHOD: Searches of bibliographic databases and internet sites were supplemented with manual searches of journals of relevance to wound management for clinical data relating to the use of Mepitel. RESULTS: The literature search identified a number of articles, presenting data generated from randomized controlled trials, non-randomized controlled trials and case study evaluations of Mepitel on a wide range of wound types and skin injuries. CONCLUSION: The results of the clinical evaluations demonstrate that Mepitel is associated with atraumatic and virtually pain-free dressing changes. The dressing with Safetac can be used cost-effectively in the treatment of a wide range of wound types and skin injuries.

A comparison of the cost effectiveness of pressure-indicating materials and their ability to detect pressure areas in complete dentures.

Pressure areas on the fitting surfaces of dentures can cause great discomfort and pain to denture wearers if not detected and removed. Pressure-indicating materials are commonly used to detect these areas, and several commercial varieties are available, but these tend to be expensive. The cost effectiveness of these materials has not been investigated, nor has this been linked to their efficacy and ease of use. The aim of this study therefore, was to compare the different pressure-indicating materials available commercially with that of a home-made paste. An assumption of efficacy was made by the number and size of pressure areas revealed, by taking standardised photographs and analysing the images. User friendliness was determined by the time taken to mix, apply and remove the material. Cost was determined by a cost per unit calculation based on the average or minimum quantity required for each material. The results indicated that a home-made paste made of equal quantities of hand lanolin (BP) and zinc oxide powder was not only the most effective, but was also the cheapest, being only 3% of the cost of the most expensive of the materials.