{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:09:19Z","timestamp":1793408959111,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T00:00:00Z","timestamp":1578268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Partial thickness burns not undergoing surgical excision are treated with topical silver products including silver sulfadiazine (SSD) and Mepilex Ag. Skin allograft is a more costly alternative that acts as definitive wound coverage until autogenous epithelialization. Economic constraints and the movement toward value-based care demand cost and outcome justification prior to adopting more costly products.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cost-utility analysis was performed comparing skin allograft to SSD and Mepilex Ag using decision tree analysis. The base case modeled a superficial partial thickness 20% total body surface area burn. Utilities were derived from expert opinion on the basis of personal experience. Costs were derived from 2019 Medicare payments. Quality adjusted life years were calculated using rollback method assuming standard life expectancies in the United States. Probabilistic sensitivity analysis was performed to asses model robustness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The incremental costs of skin allograft to Mepilex Ag and SSD were $907.71 and $1257.86, respectively. The incremental quality adjusted life year (QALY) gains from allograft over Mepilex Ag and SSD were 0.011 and 0.016. This yielded an incremental cost-utility ratio for allograft vs. Mepilex Ag of $84,189.29\/QALY compared with an incremental cost-utility ratio of $79,684.63\/QALY for allograft vs. SSD. Assuming willingness-to-pay thresholds of $100,000\/QALY, probabilistic sensitivity analysis demonstrated that allograft was cost effective to Mepilex Ag in 62.1% of scenarios, and cost effective to SSD in 64.9% of simulations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Skin allograft showed greater QALYs compared with topical silver dressings at a higher cost. Depending on willingness-to-pay thresholds, skin allograft may be a considered a cost-effective treatment of partial-thickness burns.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jbcr\/iraa003","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T05:27:55Z","timestamp":1578288475000},"page":"450-456","source":"Crossref","is-referenced-by-count":12,"title":["The Optimal Treatment for Partial Thickness Burns: A Cost-Utility Analysis of Skin Allograft vs. Topical Silver Dressings"],"prefix":"10.1093","volume":"41","author":[{"given":"Clifford C","family":"Sheckter","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery. Stanford University, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nickolas L","family":"Meyerkord","sequence":"first","affiliation":[{"name":"Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunna L","family":"Sinskey","sequence":"first","affiliation":[{"name":"Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pariss","family":"Clark","sequence":"first","affiliation":[{"name":"Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Anderson","sequence":"first","affiliation":[{"name":"Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Van Vliet","sequence":"first","affiliation":[{"name":"Burn and Reconstructive Centers of Florida. Blake Medical Center. Bradenton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"issue":"1","key":"2020050201585310200_CIT0001","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/00004630-199501000-00017","article-title":"Regional and institutional variation in burn care","volume":"16","author":"Fakhry","year":"1995","journal-title":"J Burn Care Rehabil."},{"issue":"2","key":"2020050201585310200_CIT0002","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0305-4179(99)00108-4","article-title":"Historical review of the use of silver in the treatment of burns. I. Early uses","volume":"26","author":"Klasen","year":"2000","journal-title":"Burns."},{"issue":"2","key":"2020050201585310200_CIT0003","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S0305-4179(99)00116-3","article-title":"A historical review of the use of silver in the treatment of burns. II. Renewed interest for silver","volume":"26","author":"Klasen","year":"2000","journal-title":"Burns"},{"issue":"5","key":"2020050201585310200_CIT0004","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/0007-1226(89)90050-7","article-title":"Silver sulphadiazine and the healing of partial thickness burns: a prospective clinical trial","volume":"42","author":"Stern","year":"1989","journal-title":"Br J Plast Surg."},{"issue":"6","key":"2020050201585310200_CIT0005","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/BCR.0b013e318236fe31","article-title":"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","volume":"32","author":"Silverstein","year":"2011","journal-title":"J Burn Care Res."},{"issue":"3","key":"2020050201585310200_CIT0006","article-title":"Dressings for superficial and partial thickness burns","author":"Wasiak","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2020050201585310200_CIT0007","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/01.BCR.0000112331.72232.1B","article-title":"Microbicidal properties of a silver-containing hydrofiber dressing against a variety of burn wound pathogens","volume":"25","author":"Bowler","year":"2004","journal-title":"J Burn Care Rehabil."},{"issue":"4","key":"2020050201585310200_CIT0008","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/BCR.0b013e3182a36916","article-title":"Cost-effectiveness comparison between topical silver sulfadiazine and enclosed silver dressing for partial-thickness burn treatment","volume":"35","author":"Sheckter","year":"2014","journal-title":"J Burn Care Res."},{"issue":"7","key":"2020050201585310200_CIT0009","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S0305-4179(03)00161-X","article-title":"A randomised clinical trial comparing a hydrocolloid-derived dressing and glycerol preserved allograft skin in the management of partial thickness burns","volume":"29","author":"Vloemans","year":"2003","journal-title":"Burns."},{"issue":"6","key":"2020050201585310200_CIT0010","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.burns.2009.03.007","article-title":"The application of glycerol-preserved skin allograft in the treatment of burn injuries: an analysis based on indications","volume":"36","author":"Khoo","year":"2010","journal-title":"Burns."},{"issue":"13","key":"2020050201585310200_CIT0011","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1056\/NEJM197703312961304","article-title":"Foundations of cost-effectiveness analysis for health and medical practices","volume":"296","author":"Weinstein","year":"1977","journal-title":"N Engl J Med."},{"issue":"1","key":"2020050201585310200_CIT0012","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/0305-4179(89)90074-0","article-title":"Clinical experience with glycerol-preserved donor skin treatment in partial thickness burns","volume":"15","author":"Hermans","year":"1989","journal-title":"Burns Incl Therm Inj."},{"key":"2020050201585310200_CIT0013","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/S0305-4179(02)00087-6","article-title":"A historical appraisal of the use of cryopreserved and glycerol-preserved allograft skin in the treatment of partial thickness burns","volume":"28","author":"Vloemans","year":"2002","journal-title":"Burns."},{"issue":"4-5","key":"2020050201585310200_CIT0014","doi-asserted-by":"crossref","first-page":"200","DOI":"10.3109\/2000656X.2011.583515","article-title":"Suprathel(\u00ae) causes less bleeding and scarring than Mepilex(\u00ae) Transfer in the treatment of donor sites of split-thickness skin grafts","volume":"45","author":"Kaartinen","year":"2011","journal-title":"J Plast Surg Hand Surg."},{"issue":"1","key":"2020050201585310200_CIT0015","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/j.1742-481X.2006.00276.x","article-title":"Randomised clinical trial of Hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds","volume":"4","author":"Jurczak","year":"2007","journal-title":"Int Wound J."},{"issue":"3","key":"2020050201585310200_CIT0016","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/j.1464-5491.2007.02079.x","article-title":"Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers","volume":"24","author":"Jude","year":"2007","journal-title":"Diabet Med."},{"issue":"2","key":"2020050201585310200_CIT0017","doi-asserted-by":"crossref","first-page":"274e","DOI":"10.1097\/PRS.0b013e3182589d63","article-title":"Effectiveness of cerium nitrate-silver sulfadiazine in the treatment of facial burns: a multicenter, randomized, controlled trial","volume":"130","author":"Oen","year":"2012","journal-title":"Plast Reconstr Surg."},{"issue":"8","key":"2020050201585310200_CIT0018","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1097\/00005373-198808000-00022","article-title":"Biosynthetic skin substitute vs. 1% silver sulfadiazine for treatment of inpatient partial-thickness thermal burns","volume":"28","author":"Gerding","year":"1988","journal-title":"J Trauma."},{"issue":"2","key":"2020050201585310200_CIT0019","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0196-0644(05)81793-7","article-title":"Outpatient management of partial-thickness burns: biobrane versus 1% silver sulfadiazine","volume":"19","author":"Gerding","year":"1990","journal-title":"Ann Emerg Med."},{"issue":"4","key":"2020050201585310200_CIT0020","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/00004630-199907000-00002","article-title":"Safety and efficacy of TransCyte for the treatment of partial-thickness burns","volume":"20","author":"Noordenbos","year":"1999","journal-title":"J Burn Care Rehabil."},{"issue":"4","key":"2020050201585310200_CIT0021","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/0305-4179(92)90153-L","article-title":"DuoDERM hydroactive dressing versus silver sulphadiazine\/Bactigras in the emergency treatment of partial skin thickness burns","volume":"18","author":"Afilalo","year":"1992","journal-title":"Burns."},{"issue":"7","key":"2020050201585310200_CIT0022","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/00005373-199007000-00016","article-title":"Comparison of a hydrocolloid dressing and silver sulfadiazine cream in the outpatient management of second-degree burns","volume":"30","author":"Wyatt","year":"1990","journal-title":"J Trauma."},{"issue":"5","key":"2020050201585310200_CIT0023","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/j.1742-481X.2010.00717.x","article-title":"Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns","volume":"7","author":"Malik","year":"2010","journal-title":"Int Wound J."},{"issue":"2","key":"2020050201585310200_CIT0024","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0305-4179(97)00113-7","article-title":"A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine","volume":"24","author":"Subrahmanyam","year":"1998","journal-title":"Burns."},{"issue":"4","key":"2020050201585310200_CIT0025","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/SAP.0b013e3180326fcf","article-title":"A liposome hydrogel with polyvinyl-pyrrolidone iodine in the local treatment of partial-thickness burn wounds","volume":"59","author":"Homann","year":"2007","journal-title":"Ann Plast Surg."},{"issue":"1","key":"2020050201585310200_CIT0026","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00004630-199401000-00003","article-title":"Collagenase ointment and polymyxin B sulfate\/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns: a pilot study","volume":"15","author":"Soroff","year":"1994","journal-title":"J Burn Care Rehabil."},{"issue":"3 Pt 1","key":"2020050201585310200_CIT0027","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00004630-199505000-00004","article-title":"Wound healing in partial-thickness burn wounds treated with collagenase ointment versus silver sulfadiazine cream","volume":"16","author":"Hansbrough","year":"1995","journal-title":"J Burn Care Rehabil."},{"issue":"9-10","key":"2020050201585310200_CIT0028","first-page":"105","article-title":"A comparison of topical Phenytoin with Silverex in the treatment of superficial dermal burn wounds","volume":"48","author":"Carneiro","year":"2002","journal-title":"Cent Afr J Med."},{"key":"2020050201585310200_CIT0029","author":"American Burn Association."},{"key":"2020050201585310200_CIT0030","author":"Institute for Clinical and Economic Review.","year":"2017"},{"issue":"1","key":"2020050201585310200_CIT0031","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s10561-009-9152-1","article-title":"The use of human deceased donor skin allograft in burn care","volume":"11","author":"Leon-Villapalos","year":"2010","journal-title":"Cell Tissue Bank."},{"issue":"1","key":"2020050201585310200_CIT0032","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1093\/ilar\/ilv016","article-title":"Gibran, porcine models of cutaneous wound healing","volume":"56","author":"Max","year":"2015","journal-title":"ILAR"},{"key":"2020050201585310200_CIT0033","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.1093\/jbcr\/iry006.121","article-title":"118 Omega-3 rich fish skin grafts in the treatment of full thickness burns: a comparative trial of fish skin and cadaver skin in a porcine model","volume":"39","author":"Kjartansson","year":"2018","journal-title":"J Burn Care Res"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/iraa003\/32429048\/iraa003.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/41\/3\/450\/33154627\/iraa003.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jbcr\/article-pdf\/41\/3\/450\/33154627\/iraa003.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,2]],"date-time":"2020-05-02T05:59:10Z","timestamp":1588399150000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/41\/3\/450\/5696803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,6]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,1,6]]},"published-print":{"date-parts":[[2020,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/iraa003","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"value":"1559-047X","type":"print"},{"value":"1559-0488","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2020,1,6]]}}}