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Annals of Burns and Fire Disasters logoLink to Annals of Burns and Fire Disasters
. 2023 Sep 30;36(3):183–188.

Cost Analysis and Influencing Factors Amongst Severe Burn Patients

Analyse De CoÛt De Prise En Charge Des BrÛlÉs Graves Et Des Facteurs L’nÇant

NN Lam 1,2,, NT Hung 1,2, NN Khanh 3
PMCID: PMC11041904  PMID: 38680437

SUMMARY

This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.

Keywords: burn, treatment cost, influence factors

Introduction

In recent years, the treatment of burn patients has made significant progress as a result of advances in comprehensive care, early surgical intervention, fluid resuscitation, nutrition and infectious control.1,2 However, along with that, the cost of treating burn patients has also significantly increased.3-5 As a result, determining the cost of treating burn patients is an important tool, with regard to resource allocation, treatment and prevention strategies.6 Most reports about the costs for burn care were recorded in developed countries.7 Currently, there is still limited research about factors influencing treatment cost for severe burn patients, especially in developing countries. The objective of this study was to analyze the structure and factors influencing cost of treatment for severe burn patients treated at the Viet Nam National Burn Hospital.

Patients and methods

A retrospective study was conducted on 299 severe burn patients, defined as burn extent ≥20% total body surface area (TBSA), treated at Viet Nam National Burn Hospital from January 1, 2021 to December 31, 2021. Patients hospitalized less than 3 days were excluded from the study. Collection criteria included patient features such as age, gender, health insurance; burn characteristics including causal agent, burn extent, deep burn area, inhalation injury and outcomes (death or survivor); treatment costs including total costs as well as cost details regarding laboratory tests, medication and consumable medical equipment, surgical and procedures intervention, and blood products. Treatment costs were compared according to patient characteristics, burn injury characteristics and patient outcome (survivor or death). Multivariate regression analysis was carried out to identify independent factors affecting the cost of treatment. Data were collected, presented as mean or median (if unstandardized distribution), and analyzed using Stata software version 14.0, with p value <.05 regarded as the significant level.

Results

Of the 299 patients, 71.9% were adult, 79.9% were male and 90.3% had medical insurance. Average burn extent was 31% TBSA with 13.7% of patients suffering inhalation injury. Death rate was recorded at 7.7%. The average total cost of treatment for 1 patient was 3275.9 USD, of which health insurance covered 58.1%. The average treatment cost for 1 day of hospital stay was 113.3 USD and the treatment cost for 1% burn area was 109.5 USD (Table I).

Table I.

Patient characteristics

Characteristics Subgroup N %
Age Children 63 21.1
Adult 215 71.9
Elderly 21 7
Average, year 33.07 ±1.1
Gender Male 239 79.9
Female 60 20.1
Health insurance 270 90.3
Causal agent Scald 69 23.1
Flame of heat surface 181 60.5
Electricity 44 14.7
Chemical agents 5 1.7
Burn area, %BSA 31 (23-44)
Deep burn area, %BSA 4 (0-14)
Inhalation injury 41 13.7
Death 23 7.7
Treatment cost
(USD)
Total cost, median 3275.9 (1700.1-7841.9)
1 day of treatment 113.3 (77.3-210.1)
1% burn surface area 109.5 (60.0-186.8)

BSA = body surface area; IQR = Interquartile range

In terms of structure, medication and consumable medical equipment accounted for the highest proportion of costs (43.2%), followed by expenses for surgery and procedures (30.2%). The cost for blood products was lowest, accounting for only 1.3% (Table II).

Table II.

Treatment cost details

Laboratory tests 120.4 3.6
Surgery, procedures 1073.4 30.2
Blood products 48.9 1.3
Medication, consumable medical equipment 1282.6 43.2
Other* 607.3 18.3
Total 3275.9 (100) 100

* Meals, family and optional services

The relationship between patient characteristics, burn features and treatment costs is shown in Table III. As can be seen, gender did not significantly affect the cost of treatment. The highest costs were seen in the elderly patients, followed by the adult group. In addition, treatment costs were significantly higher in patients with inhalation injury (12,204.9 vs. 2862.6 USD; p <.01). Regarding causal agents, the highest treatment costs were recorded in the group of electrical burns, followed by chemical burns (p <.01). Furthermore, costs also remarkably increased along with burn extent and deep burn area (p <.001).

Table III.

Treatment costs by patient characteristics

Age, median Children (n=63) 2705.8 (1638.7-3756.6) .04
Adult (n=219) 3677.0 (1626.7-8244.1)
Elderly (n=21) 4442.6 (2543.7-12856.1)
Gender, median Male (n=239) 3275.9 (1557.7-6885.9) .26
Female (n=60) 3402.1 (2301.8-8816.5)
Causal agent, median Scald (n=69) 2104.2 (1237.9-2989.3) .001
Flame or heat surface (n=181) 4093.0 (1756.8-8915.9)
Electricity (n=44) 4885.2 (3212.9-8840.3)
Chemical agents (n=5) 4670.9 (1834.9-10364.6)
Inhalation injury, median Yes (n=41) 12,204.9 (6666.9-17650.7) .001
No (n=258) 2862.6 (1537.5-5715.7)
Burn extent, median 20-49% (n=232) 2681.0 (1473.6-4834.8) .001
≥50 % TBSA (n=67) 11,204.2 (5972.5-17126.3)
Deep burn area, median 0-19% TBSA (n=136) 2156.3 (1174.9-7533.3) .001
≥20% TBSA (n=163) 4342.6 (2830.0-7918.2)

TBSA = Total body surface area

Multivariate regression analysis showed that burn burns area, deep burn area and inhalation injury are independent factors affecting the cost of treating burn patients. Causal agent and age did not independently affect the cost of burn treatment (Table IV).

Table IV.

Multivariate regression analysis of factors affecting treatment costs

Age 0.5 .4 .21 -.3÷1.2
Electrical injury 36.5 20.6 .08 -4÷76.9
Burn extent 2.5 .6 .001 1.4÷3.7
Deep burn area 2.8 .6 .001 1.6÷4.1
Inhalation injury 60.8 25.6 .018 10.3÷111
_cons. -14.8 221.9 .5 -57.8÷28.3

The relationship between outcome and treatment cost is indicated in Table V. The costs of laboratory tests, blood products, medication and medical supplies were significantly higher in the non-survival group (p <.05). There was no significant difference in the cost of surgery and procedures between the two groups (p >.05). The costs for daily treatment and the whole course of treatment in dead patients were also significantly higher than those in surviving patients (p <.001).

Table V.

Relationship between outcome and treatment cost (USD)

Cost details Survivor
(n=276)
Death
(n=23)
p
Laboratory test, median 112.5 (55.7-222.9) 561.9 (225.4-868.8) .001
Operation, procedures, median 1046.9 (510.3-1990.2) 1767.6 (450.5-2343.4) .34
Blood products, median 43.5 (0-137.2) 174.1 (81.3-490.7) .001
Medicines, medical supplies 1228.5 (589.5-3489.3) 4563.1 (1021.8-11615.4) .01
Other costs, median 608.0 (359.4-1105.1) 470.8 (147.2-686.4) .005
Cost/1 day of treatment, median 107.5 (76.2-179.8) 662.4 (409.3-1027.6) .001
Total cost, median 112.5 (55.7-222.9) 561.9 (225.4-868.8) .03

Discussion

There is no doubt that the cost of burn care is still very high and much higher than that for other diseases or trauma. In high income countries, Willenberg et al. reported the median cost of acute care for trauma patients was 22,448 USD (IQR: 11,819-33,701 USD).8 In European countries, for elderly trauma patients, a report by Van der Vlegel and coworkers indicated a mean cost of 4710 € per patients during their stay in hospital.9 For breast cancer, the costs ranged from 11,208 USD to 29,780 USD.10 Compared with other diseases and injuries, burn patients undergo a longer time of hospitalization and intensive care, with multiple operations and procedures such as necrosis excision, auto- and allo- skin graft, daily dressing change, long mechanical ventilation, expensive local and systemic medication, and expensive consumable medical equipment. Number of excision and autografting procedures increased with burn extent and burn severity.11-15

Jeevan et al. in 2014 conducted a study in the UK and found that the total cost per burn patient ranged from 2527.77 to 31,870.95 GBP.16 In Finland, the average cost per hospital stay was 24,400 USD/1% of deep burn area.17 For mass burn injuries, Mathew and colleagues analyzed data of 48 patients at Chang Gung Memorial Hospital after the Color Dust explosion in Taiwan and found that the average cost per patient was 50,848 USD.18

For daily cost of burn care, studies have reported a variety of results. In Australia, Ahn and Maitz reported the average cost per day of hospital stay to be from 3677.35 to 6263.71 AUD/1% of deep burn area.19 Patil et al. reported that the daily cost for burn patients in France was 934 USD, in Germany it was 726 USD, and in Hungary it was 280.12 USD.20

In the developing world, some studies have reported treatment costs for burn patients, and in general burn care cost was much lower than that in developed countries. For example, in India, Ahuja and Goswami reported the mean treatment cost for burn patients was 1060.52 USD and the average daily treatment cost was 134.96 USD.21 Another study in Brazil by Anami and colleagues indicated that the average cost of burn care was 39,594.9 USD, the average daily cost was 1330.48 USD.22 In 2002, a study by Rangraz Jeddi et al. in Iran indicated that the mean cost per patient was 5445.53 USD.23 In Nepal, Poudel et al. indicated the mean costs were 896.4 USD for partial burn, 1725 USD for mixed partial-deep burn, and 4,227.6 for deep burn. The largest proportion of costs was for surgery, dressings and bed charges.24 In our study, the treatment cost was 3275.9 USD and was 113.3 USD per one day of hospitalization, meanwhile average cost for 1% burn area was 109.5 USD.

The point of high consensus on the structure of costs for treating burn patients in both developed and developing countries is that the medicine accounts for the highest proportion of costs. Anami and colleagues reported that medication and blood products represented the highest proportion of costs (18,086.09 USD).22 For mass burn injuries, Mathew and colleagues reported medication fees (11%) to be one of the three highest cost drivers.18 In recent study, we found that medicines and medical supplies accounted for 43.2% of total cost.

Determining factors affecting health-care costs could help to improve patient management and may reduce costs in the future. Studies also investigated the relationship between the cost of treating burn patients and patient characteristics and burn features. According to Haikonen et al., increased age significantly affects treatment costs as these patients suffer comorbidities, slower wound healing progress, more complications, and longer hospital stay.17 An analysis by Sahin and colleagues about the relationship between cost and causal agent found that the total cost for electrical burns was highest (2,2501-2.4039 USD), followed by fire (1.3849-1.6523). USD).25 A study in Iran on 143 severe burn patients also indicated that the cost for electrical burn patients was higher than for the others.23 In a recent study, treatment costs for patients with electrical burns were highest. Anami et al. analyzed the treatment cost of 180 patients with burn extent over 20% TBSA and found that the cost of treatment increased along with burned surface area and was significantly higher in the patients with inhalation injury.22 In Taiwan, mass burn patients with burn extent ≥50% TBSA represented 63.8% of the total expenses.20

To the best of our knowledge, there have been few reports on multivariate logistic analysis to find out independent factors influencing the cost of burn care. In a recent study, with bivariate analysis, we found that the cost of treating burn patients was significantly higher in older patients, electrical injury, inhalation injury and large burn extent. However, multivariate analysis indicated that age and electrical injury did not independently affect the cost.

Regarding the relationship between outcome and treatment cost, most studies reported that costs for non-survivors were significantly higher than those for survivors. In our study, the total cost of treatment and the cost of one day of treatment in the death group was higher than that in the survivor group (p <0.05). This result is consistent with some other studies. In the United States, for instance, Holmes et al. in 2008 found that the average cost of treatment for patients who died was three times higher than for survivors (44,136 vs. 13,208 USD).2 According to Koljonen et al., the cost of treatment for patients who died was twice as high as that of the patients who survived.26

Total cost includes direct and indirect expenses. Direct cost is related to hospital costs. Indirect cost, including loss of working days, reflects the burden of burns on society. Most of the current reports were on direct cost, and our study also only mentioned direct cost. In the future it is necessary to conduct studies on both direct and indirect costs for burn patients, as well as the balance between treatment cost and quality of life.13

Conclusion

The cost of treating burn patients is still high, with the highest proportion allocated to medication and consumable medical equipment. Higher treatment costs were significantly found for the group of non-survivors. Burn extent, deep burn area and inhalation injury were independent factors affecting the treatment cost of patients with severe burns.

BIBLIOGRAPHY

  • 1.Atiyeh B, Masellis A, Conte F: Optimizing burn treatment in developing low-and middle-income countries with limited health care resources (part 3). Ann Burns Fire Disasters, 23(1): 13-18, 2010. [PMC free article] [PubMed] [Google Scholar]
  • 2.Holmes JH: Critical issues in burn care. J Burn Care Res, 29 (suppl2pt_6): S180-S187, 2008. [DOI] [PubMed] [Google Scholar]
  • 3.Saavedra PAE, De Oliveira Leal JV, Areda CA, Galato D: The costs of burn victim hospital care around the world: a systematic review. Iran J Public Health, 50(5): 866-878, 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Hop MJ, Polinder S, Van der Vlies CH, Middelkoop E, Van Baar ME: Costs of burn care: a systematic review. Wound Repair Regen, 22(4): 436-450, 2014. [DOI] [PubMed] [Google Scholar]
  • 5.Hop MJ, Wijnen BFM, Nieuwenhuis MK, Dokter J, et al. : Economic burden of burn injuries in the Netherlands: a 3 months follow up study. Injury, 47(1): 203-2010, 2016. [DOI] [PubMed] [Google Scholar]
  • 6.Delaplain PT, Joe VC: Problems and costs that could be addressed by improved burn and wound care training in health professions education. AMA J Ethics, 20(6): 560-566, 2018. [DOI] [PubMed] [Google Scholar]
  • 7.Abdelrahman I, Steinvall I, Fredrikson M, Sjoberg F, Elmasry M: Use of the burn intervention score to calculate the charges of the care of burns. Burns, 45(2): 303-309, 2019. [DOI] [PubMed] [Google Scholar]
  • 8.Willenberg L, Curtis K, Taylor C, et al. : The variation of acute treatment costs of trauma in high-income countries. BMC Health Serv Res, 12:267, 2012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Van der Vlegel M, Haagsma JA, Geraerds AJLM, de Munter L, et al. : Health care costs of injury in the older population: a prospective multicentre cohort study in the Netherlands. BMC Geriatr, 20(1): 417, 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Roman E, Cardoen B, Decloedt J, et al. : Variability in hospital treatment costs: a time-driven activity-based costing approach for early-stage invasive breast cancer patients. BMJ Open, 10: e035389, 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Chukamei ZG, Mobayen M, Toolaroud PB, Ghalandari M, Delavari S: The length of stay and cost of burn patients and the affecting factors. Int J Burns Trauma, 11(5): 397-405, 2021. [PMC free article] [PubMed] [Google Scholar]
  • 12.Eser T, Kavalci C, Aydogan C, Kayipmaz AE: Epidemiological and cost analysis of burn injuries admitted to the emergency department of a tertiary burn center. Springerplus, 5(1): 1-6, 2016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Kamolz LP, Sendlhofer G, Lumenta D: Future burn care: balancing the relationship between cost and quality. Wound Repair Regen, 22(4): 433-434, 2014. [DOI] [PubMed] [Google Scholar]
  • 14.Kruger E, Kowal S, Bilir SP, Han E, Foster K: Relationship between patient characteristics and number of procedures as well as length of stay for patients surviving severe burn injuries: analysis of the American Burn Association National Burn Repository. J Burn Care Res, 41(5): 1037-1044, 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Yu TC, Zhang X, Smiell J, Zhou H, Tan R, Böing E, et al. : Healthcare resource utilization, treatment patterns, and cost of care among patients with thermal burns and inpatient autografting in two large privately insured populations in the United States. Burns, 46(4): 825-835, 2020. [DOI] [PubMed] [Google Scholar]
  • 16.Jeevan R, Rashid A, Lymperopoulos N, et al. : Mortality and treatment cost estimates for 1075 consecutive patients treated by a regional adult burn service over a five year period: the Liverpool experience. Burns, 40(2): 214-222, 2014. [DOI] [PubMed] [Google Scholar]
  • 17.Haikonen K, Lillsunde PM, Vuola J: Inpatient costs of fire-related injuries in Finland. Burns, 40(8): 1754-1760, 2014. [DOI] [PubMed] [Google Scholar]
  • 18.Mathews AL, Cheng MH, Muller JM, Lin MC, et al. : Cost analysis of 48 burn patients in a mass casualty explosion treated at Chang Gung Memorial Hospital. Injury, 48(1): 80-86, 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Ahn CS, Maitz PK: The true cost of burn. Burns, 38(7): 967-974, 2012. [DOI] [PubMed] [Google Scholar]
  • 20.Patil V, Dulhunty JM, Udy A, et al. : Do burn patients cost more? The intensive care unit costs of burn patients compared with controls matched for length of stay and acuity. J Burn Care Res, 31: 598-602, 2010. [DOI] [PubMed] [Google Scholar]
  • 21.Ahuja RB, Goswami P: Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India. Burns, 39(4): 558-564, 2013. [DOI] [PubMed] [Google Scholar]
  • 22.Anami EH, Zampar EF, Tanita MT, et al. : Treatment costs of burn victims in a university hospital. Burns, 43(2): 350-356, 2017. [DOI] [PubMed] [Google Scholar]
  • 23.Rangraz Jeddi F, Mobayen M, Feizkhah A, Farrahi R, et al. : Cost analysis of the treatment of severe burn injuries in a Tertiary Burn Center in Northern Iran. Iranian Red Crescent Medical Journal, 24(5), 2022, 10.32592/ircmj.2022.24.5.1522. [DOI] [Google Scholar]
  • 24.Poudel AN, Price P, Lowin J, Shilpakar R, et al. : The cost of inpatient burn management in Nepal. Burns, 47(7): 1675-1682, 2021. [DOI] [PubMed] [Google Scholar]
  • 25.Sahin I, Ozturk S, Alhan D, et al. : Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience. Ann Burns Fire Disasters, 24(1): 9, 2011. [PMC free article] [PubMed] [Google Scholar]
  • 26.Koljonen V, Laitila M, Rissanen AM, et al. : Treatment of patients with severe burns costs and health-related quality of life outcome. J Burn Care Res, 34(6): e318-e325, 2013. [DOI] [PubMed] [Google Scholar]

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