A Cost Model Case Comparison of Current Versus Modern Management of Burns at a Regional Hospital in South Africa

Introduction: Institutional data shows a high burden of burn injury, which is managed by a conservative delayed approach. This is daily dressing until spontaneous eschar separation occurs followed by delayed skin grafting. Early excision and grafting is considered active management and is shown to be more cost effective in first world situations. We developed a costing model for both approaches to analyse financial costs in a developing country burns unit.

Methods: Utilising previous audit data of burn care at our institution, a costing model was developed. Individual cost drivers such as dressing, analgesia, theatre costs, and hospital stay were identified. Cost for each driver was multiplied by number of patients and or number of days in hospital. Total cost was a summation of these individual drivers. The costs derived from this model were compared to the cost of care of a single patient in which the burn wound was actively managed.

Results: The total cost of care for patients admitted with a burn injury was 29,549,750 ZAR. The estimated total cost of the single patient with a 20% body surface area deep dermal thickness burn treated conservatively at our institution was estimated at 154,000 ZAR, compared with a single patient with equivalent injury treated with an active approach costing 103,000 ZAR. The potential cost saving was ten million rand.

Conclusion: This simple cost model suggests considerable savings could be made with active burn wound management implementation. Accurate costing of a larger cohort should define these savings more accurately.