OBJECTIVES: Treating burns from intentional threats or accidents is costly, due to the need for complex and individualized care. Currently, no validated economic model is available to assess the costs and clinical impact of new interventions versus standard of care (SOC) for inpatient treatment of acute burns. To address this limitation, an economic model was developed to permit cost-effectiveness analyses and provide budget impact modeling of new interventions to manage burns (total body surface area [TBSA] 10%+) along the care continuum in the US. Accuracy of predictions was validated against average costs from the American Burn Association National Burn Registry (NBR) database.

METHODS: A Microsoft Excel hospital-perspective model was developed using sequential decision trees to estimate resource use and costs for five care phases (wound assessment, debridement/excision, temporary coverage, permanent closure, and rehabilitation). Regression equations utilized NBR data to inform number of procedures (autograft, debridement, excision), and length of stay (LOS). All other clinical inputs were derived from published studies and burn surgeon interviews. Hospital resource use and unit costs were obtained from surveying three hospital administrators.

RESULTS: Model equations accurately predicted number of procedures and LOS. Controlling for patient characteristics and comorbidities, total predicted costs were $111,217, $177,830 and $301,516 for adults (18+) with TBSA <15%, 15-25 and 25-40% respectively, within 2.8-8% of NBR costs. For pediatrics, predicted costs were less accurate: $73,678, $140,120 and $267,553 per TBSA category versus $59,937, 104,137 and $228,764 in the NBR (difference of 17-35%).

CONCLUSIONS: This is the first economic model examining the continuum of definitive care in burns. This allows for a comprehensive comparison of value of new burn treatments versus SOC. The model accurately predicts costs for adults; however, results showed less accurate predictions for pediatrics. Future work to better inform pediatric hospital cost data will improve accuracy, aiding in decision-making.