Healthcare Resource Utilization and Costs of Care Among Pediatric Patients with Thermal Burns Undergoing Inpatient Autografting in a US Managed Care Population

INTRODUCTION: Autograft is considered the standard of care for severe burns; however, data on the economic outcomes in the pediatric population are sparse. This study assessed the healthcare resource utilization (HCRU) and costs of care among pediatric patients undergoing autografting for thermal burns.

METHODS: The HealthCore Integrated Research Database was used to identify patients < 18 years old with thermal burns receiving the first inpatient autograft between 1/1/2011 and 6/30/2016. The first admission date was assigned as the index date; 12-month pre- and 24-month post-index-date eligibilities were required. Patient demographics, clinical characteristics, HCRU, and total costs were assessed.

RESULTS: Of 65 identified patients, mean age was 7.2 years (standard deviation, SD=5.19); 46.2% were < 6 years old; 69.2% were male. The commonest of burn sites were in upper limbs (64.6%) and lower limbs (52.3%).  Sixty percent of them had total body surface area (TBSA) < 10% of any-degree burn, and only a few patients (≤ 10) had TBSA burned ≥ 30%. The mean total all-cause cost in the one-year pre-index period was $14,359 (SD=$27,393), and $9,274 (SD=$25,694) of that cost were burn-related.

The average length of stay of the index hospitalization was 10.9 days (SD=10.72), with mean total cost of $94,652 (SD=$162,176). The first-year post-index mean total cost was $111,536 (SD=$174,616) and 93.5% (including index hospitalization) were burn-related. On average, the index hospitalization accounted for 84.9% of the first-year costs. The second-year mean total cost was $10,734 (SD=$40,185), with 5.9% burn-related. Very few (≤ 10) patients had a burn-related hospitalization in the first year after discharge from the index hospitalization, and none had any burn-related inpatient stay in the second year.

CONCLUSIONS: The first-year economic burden in this pediatric population was substantial, driven by the initial hospitalization for autografting. Burn-related HCRU and cost reduced considerably in the second year post-index.