Socio-economic cost and health-related quality of life of burn victims in Spain.

OBJECTIVES: The aim of the study was to determine the economic burden (direct and indirect costs) of burn victims and the impact of burn on health-related quality of life in Spain. METHODS: In 2003, a cross-sectional study was carried out with 898 burned people. Data regarding demographic features, health resource use, informal care, indirect costs and quality of life were prospectively collected through hospital admission databases and questionnaires filled out by burn victims and caregivers. RESULTS: The mean annual cost (direct and indirect) per burn patient was US$ 99,773. The most important categories of costs were those of in-patient care and temporary and permanent disability. Direct healthcare costs of burn patients represented 19.6% of the total. Total annual cost for burn patients in Spain was US$ 313 million. The mean health-related quality of life measured by European Quality of Life 5-Dimension score was 0.84 and the mean visual analogue score was 67. CONCLUSIONS: The costs of burn are higher than those of many other conditions, and a cost-effectiveness assessment of the different interventions for burn should become a priority in health policy.

Are we really seeing the total costs of surgical site infections? A Spanish study.

To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case-control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were used more intensely and for longer periods than in controls. Excess hospital costs were $10,232 per patient of which 37% corresponded to prolonged stays. Health costs only accounted for 10% of overall costs; $97,433 per patient including indirect social costs. Studies merely assessing excess costs due to prolonged stays of SSI patients do not reflect the entire scenario as they simply represent 35% of real hospital costs. A comprehensive appraisal shows that total healthcare expenditures represent a tenth of overall costs, which strengthens the claims that investment in preventing SSI would be highly cost-effective.

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.