Evaluating Health Economic Outcomes of Autologous Skin Cell Suspension (ASCS) For Definitive Closure in US Burn Care Using Contemporary Real-World Burn Center Data
Abstract
Background: As new treatments for managing patients with burn injuries become available, it is imperative to consider the overall potential impact of both patient outcomes and costs to the burn center (BC). Health economic evaluations (HEE) can aid BC to assess new treatment options. Historically, the National Burn Repository (NBR) has aided in HEE with two limitations- variables are captured in an aggregate fashion over a 10-year period and it has limited data on resource utilization and procedure types. This prohibits real-world evidence development and effective HEE for new treatments. Our goal was to collect timely real-world data (RWD) and conduct a HEE to better understand the differences between anecdotal evidence and RWD in burn care treatment patterns and outcomes.
Objective: To re-evaluate the economic impact of Autologous Skin Cell Suspension (ASCS) by conducting a primary research survey using RWD from BC on the current state of treatment care in order to identify trends since 2011 that impact evaluation of new interventions.
Methods: 10% of U.S. burn centers were surveyed in 2019 by a panel of health economists on current BC practice patterns and outcomes. Survey data functioned as RWD with NBR 8.0 data in a previously developed health economic model (BEACON). A HEE was conducted with ASCS compared to standard of care (SOC) in a cost-effectiveness model for inpatients with deep-partial thickness (DPT) and full-thickness (FT) burn injury involving >10%TBSA. The costs-effectiveness model incorporated costs of patient care from RWD and data from the NBR predictive equations method.
Results: ASCS was cost-saving in both FT and DPT burns across all TBSA ranges. Cost savings increased with burn size due to the reduced number of autograft procedures, LOS and costs compared to SOC. Savings ranged from 1% to 43% in 10% and 40 % TBSA, respectively in FT, and 25% to 41% in 10% and 40% TBSA, respectively among DPT burns. For a hypothetical BC with an average of 341 patients, the use of ASCS is expected to reduce overall costs by an estimated $15.8M for the center and $79.5K (17.4% reduction) per patient, on average.
Conclusion: The study provides the first HEE from RWD confirming the BEACON model and the potential of new technologies in burn care. We observed that use of ASCS has the potential to provide substantial financial savings to BC, corroborating findings of the original HEE of ASCS with the BEACON model.
Full text article
References
2. Centers for Disease Control and Prevention National Center for Injury Prevention and Control. Estimated Number of Nonfatal Emergency Department Visits, and Average and Total Lifetime Costs, United States, 2010. https://wisqars.cdc.gov:8443/costT/cost_Part1_Intro.jsp. Accessed March 17, 2020.
3. American Burn Association. National Burn Repository, Dataset Version 14.0. Report of data from 2009-2018. 2019 Update. https://ameriburn.org/research/burn-dataset/. Accesed June 17, 2020.
4. Norbury, W., et al., Infection in Burns. Surg Infect (Larchmt), 2016. 17(2): p. 250-5.
5. Kowal, S., et al., Cost-Effectiveness of the Use of Autologous Cell Harvesting Device Compared to Standard of Care for Treatment of Severe Burns in the United States. Advances in Therapy, 2019. 36(7): p. 1715-1729.
6. Jeschke, M.G., et al., Morbidity and survival probability in burn patients in modern burn care. Critical care medicine, 2015. 43(4): p. 808-815.
7. American College of Surgeons. Burn Specialists Report a Dramatic Increase in Burn Injury Survival Over the Past 30 Years. 2018 Update. https://www.facs.org/media/press-releases/2018/burninjury030918. Accessed March 23, 2020.
8. Hranjec, T., et al., Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"? Am Surg, 2012. 78(5): p. 559-66.
9. Lim, J., et al., Is the length of time in acute burn surgery associated with poorer outcomes? Burns, 2014. 40(2): p. 235-40.
10. Quick, A., Demonstration of the Safety and Effectiveness of ACHD® Combined with Meshed Skin Graft for Reduction of Donor Area in the Treatment of Acute Burn Injuries (CTP001-6). Avita Medical. 2017.
11. Quick, A., A Comparative Study of the ACHD® Device and Autologous Split-thickness Meshed Skin Graft in the Treatment of Acute Burn Injuriess (CTP001-5). Avita Medical. 2017.
12. American Burn Association. National Burn Repository. 2012 Report. Dataset Version 8.0.
13. American Burn Association. Burn Dataset. https://ameriburn.org/aba-registry-and-quality-programs/. Accessed March 23, 2020.
14. Kruger, E., et al., Relationship between patient characteristics and length of stay for severe burn patients: analysis of the American Burn Association National Burn Repository.
15. Gravante, G., et al., A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns. Burns, 2007. 33(8): p. 966-72.
16. Holmes Iv, J.H., et al., A Comparative Study of the ReCell(R) Device and Autologous Spit-Thickness Meshed Skin Graft in the Treatment of Acute Burn Injuries. J Burn Care Res, 2018. 39(5): p. 694-702.
17. Holmes, J.H.t., et al., Demonstration of the safety and effectiveness of the RECELL((R)) System combined with split-thickness meshed autografts for the reduction of donor skin to treat mixed-depth burn injuries. Burns, 2019. 45(4): p. 772-782.