Cost-utility analysis applied to the treatment of burn patients in a specialized center.

OBJECTIVE To discover the total costs and quality of life of burn patients in a specialist center classified by diagnosis-related groups (DRGs). DESIGN Prospective study of 5-year follow-up from January 1, 1997, through December 31, 2001. SETTING Burn Center of Valencia. PATIENTS A total of 898 patients treated at the Burn Center of Valencia. MAIN OUTCOME MEASURES Hospital, extrahospital, caregiving, labor, and social costs of the burn patients grouped by DRG (code 457: extensive burns without operating room procedure; code 458: nonextensive burns with skin graft; code 459: nonextensive burns with wound debridement or other operating room procedure; code 460: nonextensive burns without operating room procedure; or code 472: extensive burns with operating room procedure) were studied. The costs were compared with those that the DRG system assigns. The quality of life of the patients at the end of the follow-up period was also studied. To measure quality of life, the EuroQol 5-Dimensions survey was used. Utility calculations and cost-utility analysis were undertaken according to life expectancy. RESULTS The number of quality-adjusted life-years produced by the center was 13 577, with a mean quality-of-life level on release from the study of 0.87. The mean cost per patient, including the social and labor costs, was $95 551, with health care costs amounting to only 10%. The mean cost per quality-adjusted life-year was $686. CONCLUSIONS The labor costs were the most important and amounted to 56%; together with the social costs, these constituted 85% of the total costs. The DRG code 456 was an option dominated by the remaining DRG codes 458 through 460 and 472. Given the high costs of treating burn patients, a clear health care policy is urgently needed.

[1]  P. Wakker,et al.  Confidence intervals for cost/effectiveness ratios. , 1995, Health economics.

[2]  M. Mone,et al.  RETURN TO WORK AS A MEASURE OF OUTCOME IN ADULTS HOSPITALIZED FOR ACUTE BURN TREATMENT , 1994 .

[3]  Joseph S. Pliskin,et al.  Utility Functions for Life Years and Health Status , 1980, Oper. Res..

[4]  P. Thomson,et al.  A ten-year review of Candida sepsis and mortality in burn patients. , 1987, Surgery.

[5]  R. Edlich,et al.  Epidemiology of burn injuries in a rural community , 1979 .

[6]  J. Saffle,et al.  Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association Patient Registry. , 1995, The Journal of burn care & rehabilitation.

[7]  C. Tsai,et al.  An easy method for preparation of postage stamp autografts. , 2000, Burns : journal of the International Society for Burn Injuries.

[8]  Bernie J. O'Brien,et al.  In Search of Power and Significance: Issues in the Design and Analysis of Stochastic Cost-Effectiveness Studies in Health Care , 1994, Medical care.

[9]  C. G de Gracia,et al.  An open study comparing topical silver sulfadiazine and topical silver sulfadiazine-cerium nitrate in the treatment of moderate and severe burns. , 2001 .

[10]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[11]  K. Takayanagi,et al.  The cost of burn care and implications for efficient care. , 1999, Clinical performance and quality health care.

[12]  R. Alaghehbandan,et al.  Epidemiological study of 3341 burns patients during three years in Tehran, Iran. , 2000, Burns : journal of the International Society for Burn Injuries.

[13]  A. Meyer,et al.  Strategies to improve burn center utilization. , 1988, The Journal of burn care & rehabilitation.

[14]  T. Patterson,et al.  Behavioural factors in burn mortality and length of stay in hospital , 1984 .

[15]  H. Klarman,et al.  Cost Effectiveness Analysis Applied to the Treatment of Chronic Renal Disease , 1968 .

[16]  E. Yeong,et al.  Improved burn scar assessment with use of a new scar-rating scale. , 1997, The Journal of burn care & rehabilitation.

[17]  A. Reig,et al.  An epidemiological study of burn patients hospitalized in Valencia, Spain during 1989. , 1992, Burns : journal of the International Society for Burn Injuries.

[18]  G. Purdue,et al.  Diagnosis-related groupings (DRGs) and wound closure: roundtable discussion. , 1987, The Journal of burn care & rehabilitation.

[19]  B. McNeil,et al.  Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. , 1981, The New England journal of medicine.

[20]  M. Chassin.  Costs and Outcomes of Medical Intensive Care , 1982, Medical care.

[21]  J. Rey-Calero,et al.  Mortality evolution study of burn patients in a critical care burn unit between 1971 and 1991. , 1995, Burns : journal of the International Society for Burn Injuries.

[22]  J. Lofts.  Cost analysis of a major burn. , 1991, The New Zealand medical journal.

[23]  Lofts Ja.  Cost analysis of a major burn. , 1991 .

[24]  L. A. Rossi,et al.  [Burns: characteristics of cases treated in a teaching hospital in Ribeirão Preto (São Paulo), Brazil]. , 1998, Revista panamericana de salud publica = Pan American journal of public health.

[25]  J. Robinson,et al.  Philosophical origins of the economic valuation of life. , 1986, The Milbank quarterly.

[26]  M. Tambour,et al.  Bootstrap confidence intervals for cost-effectiveness ratios: some simulation results. , 1998, Health economics.

[27]  A. Eldad,et al.  The cost of an extensive burn survival. , 1993, Burns : journal of the International Society for Burn Injuries.

[28]  C G de Gracia,et al.  An open study comparing topical silver sulfadiazine and topical silver sulfadiazine-cerium nitrate in the treatment of moderate and severe burns. , 2001, Burns : journal of the International Society for Burn Injuries.

[29]  E. Luce,et al.  Early Excision and Grafting versus Conservative Management of Burns in the Elderly , 1998, Plastic and reconstructive surgery.

[30]  D. Herndon,et al.  Cost-efficacy of cultured epidermal autografts in massive pediatric burns. , 2000, Annals of surgery.

[31]  G. Torrance,et al.  The utility of different health states as perceived by the general public. , 1978, Journal of chronic diseases.

[32]  N. Zethraeus.  Willingness to pay for hormone replacement therapy. , 1998, Health economics.

[33]  D. Heimburger,et al.  Cost containment: a contribution of aggressive nutritional support in burn patients. , 1985, The Journal of burn care & rehabilitation.

[34]  J. Wheeler,et al.  The Effects of Burn Severity and Institutional Differences on the Costs of Care , 1983, Medical care.

[35]  P. Miller,et al.  A cost-benefit analysis of initial burn cultures in the management of acute burns. , 2000, The Journal of burn care & rehabilitation.

[36]  J. Järnberg,et al.  Paediatric burns in central Finland between the 1960s and the 1980s. , 1993, Burns : journal of the International Society for Burn Injuries.

[37]  P. Lyngdorf.  Epidemiology of scalds in small children. , 1986, Burns, including thermal injury.

[38]  T. Hodgson,et al.  Cost-of-illness methodology: a guide to current practices and procedures. , 1982, The Milbank Memorial Fund quarterly. Health and society.

[39]  G W Torrance,et al.  Incorporating Utility-Based Quality-of-Life Assessment Measures in Clinical Trials: Two Examples , 1989, Medical care.

[40]  J. E. Carceller.  American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis , 1992, Critical care medicine.