A Simple Cost-Saving Measure

Abstract

Objective The optimal concentration of mafenide acetate solution for use in the treatment of burns is unknown. Despite data supporting the use of a 2.5% solution, 5% formulation is traditionally used, and has been the highest costing medication on formulary. The aim of the current study is to evaluate cost and patient outcomes associated with a new policy implementing the use of 2.5% solution in burn patients and restricting the 5% formulation to specific indications only. Methods A retrospective review of all patients receiving mafenide acetate solution at a single pediatric burn hospital was performed before and after the initiation of the new policy on the use of 5% versus 2.5% solution. Duration of therapy, adverse events, cost, incidence of wound infection and bacteremia were analysed. Results In 2009, 69 patients were treated with 5% mafenide acetate solution for a total cost of $125,000 ($1811/patient). In 2010, following the initiation of the policy, 48 patients were treated: 19 received 5% mafenide acetate solution with appropriate indication, while the remaining 29 received 2.5% solution for a total cost of $38,632 ($804/patient). There were no significant changes in the incidence of bacteremia or wound infection. No side effects of either solution were noted. Conclusions Under certain conditions, a 2.5% mafenide acetate solution appears sufficient. In this multinational pediatric burn hospital, the use of a 2.5% solution was not associated with increased bacteremia or wound infection and proved to be more cost-effective.

The Effect of Antiseptics on Adipose-Derived Stem Cells

“…In chronic wounds reaching the subcutaneous tissue and particularly Pseudomonas aeruginosa (P. aeruginosa) -colonized wounds, Mafenide acetate may represent a genuine alternative to other antiseptics. Drawbacks of Mafenide acetate, however, are its high costs and a requirement for its use within 48 hours once the powder is reconstituted (45). …”

Recent Advances in Wound Healing

“…Endothelial dysfunction is a newer topic of study in the setting of trauma [61], sepsis [62], and burn injury [63]. It is known to play a role in acute burns where circulating levels of a proteoglycan component of the glycocalyx which is shed upon injury, syndecan-1 (SDC-1), is up-regulated in a dose-dependent manner in relation to injury severity.…”

“…It is effective in reducing the wound bacterial load through the inhibition of nucleoside synthesis and became especially popular in the treatment of burn wounds. First marketed as a 10% cream formulation it did not come without important side effects -both local (neoeschar formation, pain) and systemic (metabolic acidosis) [61,62]. Its concentration has later been reduced to 5%, with a reduction in the incidence of side effects, but even with preparations used today inhibitory effects on skin DNA and protein synthesis remain a concern [61][62][63].…”

“…First marketed as a 10% cream formulation it did not come without important side effects -both local (neoeschar formation, pain) and systemic (metabolic acidosis) [61,62]. Its concentration has later been reduced to 5%, with a reduction in the incidence of side effects, but even with preparations used today inhibitory effects on skin DNA and protein synthesis remain a concern [61][62][63]. This and the high cost of mafenide therapy led to recent research interests on whether the mafenide concentration could further be reduced.…”

“…This and the high cost of mafenide therapy led to recent research interests on whether the mafenide concentration could further be reduced. While the 5% mafenide acetate cream remains an important agent in burn treatment, novel research indicates that a 2,5% mafenide cream could be equally efficacious as its 5% counterpart [61,62].…”