The Cost of Inpatient Treatment of Burns at Kenyatta National Hospital

Abstract

Background: Burn injuries have a significant cost impact on the survivors and their families with associated lengthy hospital stays and loss of income. Few studies have been done internationally to quantify the cost burden of burn hospitalization. There is a paucity of data locally on what the cost burden of managing burn patients is. Study objective: To determine the cost of providing inpatient burns treatment at Kenyatta National Hospital. Materials and methods: A prospective longitudinal study design was used. The study was conducted at Kenyatta National Hospital’s burns unit and plastic surgery ward. Following ethical approval, 74 patients admitted with all types of burns in these units and who had given consent to participate were recruited into the study using non-probability consecutive sampling. Patient demographics, total burn surface area, burn depth, type of burn and costs related to treatment were assessed and recorded on an adopted KNH admission burn record chart and burn costing questionnaire. The burn care cost included all healthcare personnel fees, biological, imaging, and pathological workups, as well as drug and non-drug interventions such as surgery. The data was captured for the period of admission but not exceeding 30 days for each patient for a study duration of 3 months. Data Analysis: Collected data was assigned codes and input into SPSS (IBM version 25). Descriptive statistics such as means and frequency was computed. These were used to determine the average cost of treatment per day, per patient, the average cost per patient admission and the average cost per 1% TBSA. Categorical variables were compared using Chi-square test or Fisher’s exact test where the expected subgroup size was smaller than five. Continuous variables were presented as Mean and SD or Median and Interquartile range while Z-test or Mann-Whitney test was used to compare two continuous variables. Data analyzed was summarized and presented using tables and figures. Results: The results showed that the mean total cost of burn care at KNH was KES 122618.38 (SD = 109884.83), and the mean overall total cost was KES 123233.80 (SD = 110325.70). The cost of burn care per day was significantly influenced by the total burn surface area and the presence of inhalational injury, while the overall total cost of burn care was significantly influenced by the type of burn. There were significant differences between thermal and electrical burn patients in terms of number of days admitted, total cost of burn care at KNH, overall total cost of burn care, amount paid in cash, ambulance fee, and cost of burn care per 1% TBSA. There was also a significant association between the type of burn and the gender, with more female patients having thermal burns and more male patients having electrical burns. The results also revealed some significant correlations between some of the variables related to the cost of providing inpatient burns treatment. Conclusion: The cost of providing inpatient burns treatment at KNH is high and varies depending on several factors such as the type of burn, the total burn surface area, the presence of inhalational injury, and the number of days admitted. Most patients do not have insurance cover and have to pay out-of-pocket expenses or rely on debt waivers. This study highlights the need for more affordable and accessible burn care services in Kenya