Cost-Consequence Analysis Comparing 2-Octyl Cyanoacrylate Tissue Adhesive and Suture for Closure of Simple Lacerations: A Randomized Controlled Trial - 18/09/13
Address for reprints: T. H. Rainer, Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR; 852-2632-1033, fax: 852-2648-1469Résumé |
Study objective |
We investigate the cost difference between conventional suture and tissue adhesive methods in simple wound closure.
Methods |
A cost-consequence analysis was conducted alongside a nonblinded randomized controlled trial comparing 2-octyl cyanoacrylate tissue adhesive with conventional suture in simple lacerations closure in emergency departments (EDs) of a university teaching hospital and a major regional hospital in Hong Kong. One hundred eighty-six adult patients with simple lacerations of length within 8 cm were randomized to receive tissue adhesive (93 patients) or conventional suture (93 patients) for wound closure. The primary outcome measures were the costs to the Hospital Authority and the charges on participants incurred in each treatment method. The secondary outcome measures included the cosmetic visual analog scale, visual analog scale, Wound Evaluation Score, total time spent in each closure method, and the overall patients' satisfaction on the whole process of wound management.
Results |
The 2 groups had similar baseline characteristics. The tissue adhesive method incurred a higher cost to the Hospital Authority (216.12 [US $27.70] versus 171.33 [US $21.96]; absolute difference 44.79 [US $5.74] [95% confidence interval (CI) 32.76 to 55.95 [US $4.20 to 7.14]]) but a lower charge to patients (109.68 [US $14.06] versus 156.96 [US $20.12]; absolute difference 47.28 [US $6.06] [95% CI, 35.58 to 58.98 [US $4.56 to 7.56]) than the conventional suture method. The mean cosmetic visual analog scale score, visual analog scale score, and Wound Evaluation Score of the 2 groups were similar at various intervals within 3 months after wound closure. Compared with the suture group, the tissue adhesive group had a shorter median procedure time, fewer patients had wound erythema or swelling after wound closure, fewer patients required analgesics on discharge at ED, and there was a higher overall patient satisfaction score.
Conclusion |
Simple wounds closed by tissue adhesives incur a higher cost to the Hospital Authority than the conventional suture but may be favored by patients because of lower personal charge.
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| Supervising editor: Judd E. Hollander, MD |
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| Author contributions: THR has overseen the entire planning, execution, and analysis of the study. EMLW conceived the study and obtained approval and the grant for the study. PFL and MSC participated in staff training in the tissue adhesive application. SYM, CAG, and THR prepared the statistical analysis and were assisted by EMLW, YCN, and PSKM. EMLW and PSKM participated in data collection for the study. YCN and VL were involved in the grant proposal for the study. SYM wrote the first draft of the article and prepared the article, and all authors have contributed to the final version. THR takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Health and Health Services Research Fund (project code 03040071). No financial support was received from any commercial source to conduct this study. Competing interests: None declared. |
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| Publication dates: Available online April 28, 2008. |
Vol 53 - N° 2
P. 189-197 - février 2009 Retour au numéro
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