Exploring Cost and Treatment Patterns During Hospitalizations for Thermal Burn Patients Undergoing Autografting in a Commercially Insured Population

Introduction: Autografting is included in current standard of care for severe burns; however, little is known about economic outcomes among thermal burn patients who undergo inpatient autografting. This study filled this gap by assessing treatment patterns, health-care resource utilization (HCRU), and cost of care among thermal burn patients with inpatient autografting in a commercially insured population.

Methods: The Truven Health MarketScan® Database was used to identify thermal burn patients treated with a first inpatient autograft between 1/01/2011 and 6/30/2016. The first admission was noted as the index hospitalization. Forty-five-day pre- and six-month post-index continuous enrollments were required. Patient demographics, clinical characteristics, treatment patterns, HCRU, and total cost were reported.

Results: Of 1,695 patients included in this analysis, mean age was 36.6 years (SD=18.5), 66.3% were males, 92.4% had some third degree or deep third degree burns, and 33.7% had burns in ≥10% total body surface area (TBSA). The majority of burn sites were in upper (66.3%) or lower (56.2%) limbs. During the index hospitalizations, mean overall length of stay (LOS) was 14.2 days (SD=18.8) (mean LOS: 7.8 days for <10% TBSA, 13.1 days for 10%–19% TBSA, 21.1 days for 20%–29% TBSA, and 42.8 days for ≥30% TBSA); mean total cost was $133,613 (SD=$260,552). 31.0% of patients received synthetic substitute and 14.0% had nonautologous/homograft/ heterograft. Overall, 95.8% of patients received debridement; 7.7% were treated with respiratory intubation and mechanical ventilation; and 69.5% and 66.2% received physical therapy and occupational therapy, respectively. Approximately 64% of patients were admitted through emergency rooms (ER). During 45-day pre-index, 33.2% patients had burn-related outpatient ER visits and 13.9% had burn-related hospitalizations. Some 6.5% patients had all-cause 30-day readmissions; among them, 67.3% were burn-related.

Conclusions: The economic burden of hospitalizations for thermal burn patients who were treated with autograft was substantial. Treatment included various graft materials along with autograft during hospitalizations.