Efficacy and costs of nanocrystalline silver dressings versus 1% silver sulfadiazine dressings to treat burns in adults in the outpatient setting: A randomized clinical trial
Efficacy and costs of nanocrystalline silver dressings versus 1% silver sulfadiazine dressings to treat burns in adults in the outpatient setting: A randomized clinical trial
Data
2022
Autores
Moreira, Silvia Silva
Camargo, Mayara Costa de
Caetano, Rosângela
Alves, Maíra Ramos
Itria, Alexander
Pereira, Tiago Veiga
Lopes, Luciane Cruz
Journal Title
Journal ISSN
Volume Title
Publisher
Burns
Resumo
Background: Nanocrystalline silver dressings can reduce the number of changes, facilitating
burn wound management. However, the evidence regarding their efficacy and cost-
consequences compared to well-established treatments, such as 1% silver sulfadiazine, is
still scarce.
Objective: To determine the efficacy, safety, and costs of nanocrystalline silver dressings
compared to 1% silver sulfadiazine dressings to treat adult patients with burns.
Study design and setting: Randomized, single-center, single-blind trial conducted at a referral
hospital in São Paulo, Brazil.
Methods: 100 adult patients were randomized 1:1 to nanocrystalline silver (n = 50) or 1% silver
sulfadiazine (n = 50). The primary outcome was the proportion of participants with complete
re-epithelizationat day 15 after randomization. Secondary outcomes included thenumber of
dressing changes, direct medical costs (in international dollars, I$), pain intensity, the
incidence of infections, number of patients undergoing surgery, and adverse events.
Results: On day 15,the proportion of patients who reached the primary outcome did not differ
significantly between participants treated with nanocrystalline silver dressings (24 [48%])
and those treated with 1% silver sulfadiazine dressings (26 [52%]); risk difference of 4.0
percentage points (95% confidence interval [CI], 17 to 9; P = 0.56). The number of patients
undergoing surgical intervention was similar between groups (6% vs. 6%), and no local or
serious adverse events were reported.Themean(standard deviation, SD)number of dressing
changes in the nanocrystalline silver group was 4.1 (2.3), and the corresponding estimate in
the 1% silver sulfadiazine group was 9.6 (6.7); mean difference of 5.56 (95% CI), 7.57 to 3.55, P < 0.001). Treatment with nanocrystalline silver dressing incurred significant cost
reductions in medical materials, human resources, and administrative labor. However, the
mean total cost with nanocrystalline silver dressing was higher compared to 1% silver
sulfadiazine dressings: I$496.37 (445.90) vs. I$274.73 (182.76); mean difference = 221.63 (95%
CI, 89.04 to 354.23, P = 0.001). The main driver of higher mean total costs among
nanocrystalline silver-treated participants was the purchase cost of the dressings,
representing 79.3% of the total cost in the nanocrystalline silver group but only 15.2% in
the 1% silver sulfadiazine group.
Conclusion:We foundno evidence of a difference betweennanocrystalline silver and 1% silver
sulfadiazine dressings regarding efficacy and safety outcomes. Nanocrystalline silver
dressings were associated with an increase in the total costs, but they could result in
important savings for an institution (less changes of dressings, reducing human resources
burden), especially if acquisition costs can be decreased. Additional cost-effectiveness
studies are warranted.
Trial registration number: NCT02108535
Description
Palavras-chave
Burns, Dressings, Silver compounds, Effectiveness, Costs
Citação
Moreira SS, Camargo MC, Caetano R, Alves MR, Itria A, Pereira TV, Lopes LC. Efficacy and costs of nanocrystalline silver dressings versus 1% silver sulfadiazine dressings to treat burns in adults in the outpatient setting: A randomized clinical trial. Burns. 2022 May;48(3):568-576. doi: 10.1016/j.burns.2021.05.014.