ECONOMIC COMPARISON OF A TISSUE ADHESIVE AND SUTURING IN THE REPAIR OF PEDIATRIC FACIAL LACERATIONS

Objective: To determine, from the societal perspective, the most cost efficient of the three methods commonly used to repair pediatric facial lacerations: nondissolving sutures, dissolving sutures, or a tissue adhesive (Histoacryl blue). Design: Cost-minimization analysis and willingness-to-pay survey. Setting: Tertiary-care pediatric emergency department. Methods: All differential costs relevant to equipment utilization, pharmaceutical use, health care worker time, and parental loss of income for follow-up visits were calculated for each method. On the basis of previous research, our model assumes equal cosmetic outcome for the three methods. In addition, a convenience sample of 30 parents were surveyed in the emergency department to rank their preferences and willingness to pay for the three methods of wound closure. Results: The reduction in cost (in Canadian dollars) per patient of switching from the standard nondissolving sutures was $49.60 far switching to tissue adhesive and $37.90 for dissolving sutures, Sensitivity analyses performed on key variables did not significantly alter our conclusions. Of those parents surveyed, 90% (95% confidence interval, 74% to 98%) chose tissue adhesive and 10% (95% confidence interval, 2% to 26%) chose dissolving sutures as their first choice for wound closure. Nondissolving sutures were ranked third by 29 of 30 parents. Parents were willing to pay a median (25th to 75th percentile) of $40 ($25 to $100) for tissue adhesive and $25 ($10 to $56) for dissolving sutures if only nondissolving sutures were provided by the health care system (p = 0.1). Conclusions: Tissue adhesive is the preferred method of closure of pediatric facial lacerations because it results in the most efficient use of resources and is preferred by the majority of parents.