Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial

Cody C Frear, Bronwyn R Griffin, Leila Cuttle, Roy M Kimble, Steven M McPhail, Cody C Frear, Bronwyn R Griffin, Leila Cuttle, Roy M Kimble, Steven M McPhail

Abstract

Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant-including dressings, labour, medication, scar management, and theatre operations-were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).

Conflict of interest statement

Funding for the trial was provided by a research grant given by Smith & Nephew to the Queensland University of Technology. The funding body’s contributions to this research were limited to its financial support; it had no involvement in study design, data collection and analysis, the decision to publish, or preparation of the manuscript. C.C.F., B.R.G., L.C., R.M.K., and S.M.M. declare no other competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Incremental cost-effectiveness of adjunctive NPWT versus standard care with 95% confidence ellipse.
Figure 2
Figure 2
Incremental cost-effectiveness (and 95% confidence ellipses) from the sensitivity analyses using (a) an alternative artificial period of 24 days as an estimate of time to re-epithelialisation for grafted patients, (b) time until surgery as a proxy for time to re-epithelialisation for grafted patients, (c) theatre cost estimates reduced by 50%, and (d) a combined approach employing both time until surgery as a proxy for time to re-epithelialisation for grafted patients and theatre cost estimates reduced by 50%.

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