Cost-Effectiveness of the Use of Autologous Cell Harvesting Device Compared to Standard of Care for Treatment of Severe Burns in the United States

Abstract

Introduction: When introducing a new intervention into burn care, it is important to consider both clinical and economic impacts, as the financial burden of burns in the USA is significant. This study utilizes a health economic modeling approach to estimate cost-effectiveness and burn center budget-impact for the use of the RECELL^® Autologous Cell Harvesting Device to prepare autologous skin cell suspension (ASCS) compared to standard of care (SOC) split-thickness skin graft (STSG) for the treatment of severe burn injuries requiring surgical intervention for definitive closure.

Methods: A hospital-perspective model using sequential decision trees depicts the acute burn care pathway (wound assessment, debridement/excision, temporary coverage, definitive closure) and predicts the relative differences between use of ASCS compared to SOC. Clinical inputs and ASCS impact on length of stay (LOS) were derived from clinical trials and real-world use data, American Burn Association National Burn Repository database analyses, and burn surgeon interviews. Hospital resource use and unit costs were derived from three US burn centers. A budget impact calculation leverages Monte Carlo simulation to estimate the overall impact to a burn center.

Results: ASCS treatment is cost-saving or cost-neutral (< 2% difference) and results in lower LOS compared to SOC across expected patient profiles and scenarios. In aggregate, ASCS treatment saves a burn center 14-17.3% annually. Results are sensitive to, but remain robust across, changing assumptions for relative impact of ASCS use on LOS, procedure time, and number of procedures.

Conclusions: Use of ASCS compared to SOC reduces hospital costs and LOS of severe burns in the USA.

Funding: AVITA Medical.

Keywords: Autologous cell harvesting device; Budget impact; Burn care; Cost-effectiveness; Dermatology; Skin graft; Split-thickness.

Fig. 1

Burn model diagram. Wound assessment—the depth of wound is assessed, and a patient’s wounds are diagnosed in terms of depth. Debridement or excision—per US standard practice, DPT and FT/mixed-depth burns are surgically excised in the operating room until viable bleeding tissue is reached to prepare the wound for definitive closure. SPT burns are assumed to be debrided to remove devitalized tissue and treated using conservative management without surgery. Temporary closure—for this ASCS-focused analysis, we implicitly capture the impact of temporary coverage on LOS and cost through predictive equations derived from burn center data. However, we do not explicitly model the individual unit costs or performance of potential temporary coverage (including dermal regeneration) interventions. Note that interventions for temporary coverage are not explicitly modeled at this time; however, their impact on total cost and length of stay is implicitly considered with the NBR predictive equations. Definitive closure—in this phase of burn care, wounds that are diagnosed as requiring surgery for definitive closure (DPT, FT/mixed-depth) and receive STSG or treatment with ASCS (with or without STSG). Rehabilitation—though not a discrete phase, the model evaluates resources to capture key inpatient rehabilitation cost as well as the proportion of patients requiring contracture operations