The hospital cost of road traffic accidents at a South African regional trauma centre: A micro-costing study

doi:10.1016/j.injury.2013.04.007

Injury

Volume 45, Issue 1, January 2014, Pages 342-345

https://doi.org/10.1016/j.injury.2013.04.007 Get rights and content

Abstract

Background

Road traffic crashes are responsible for a vast amount of death and disability in developing countries. This study uses a bottom up, micro-costing approach to determine the cost of road traffic related crashes in South Africa.

Methods

Using the data from one hundred consecutive RTC related admissions to a regional hospital in South Africa we performed a bottom up costing study. To calculate costs patients were reviewed every 48 h and all interventions were recorded for each individual patient. Prices of interventions were obtained from hospital pricelists. A total cost was calculated on an individual basis.

Results

The total cost of in-patient care for these patients was US $6,98,850. Upper limb injuries were the most expensive, and the total cost increased with the number of body regions injured. The biggest expenditure was on ward overheads ($2,81,681). Ninety operations were performed – the total cost of theatre time was $1,48,230 and the cost of orthopaedic implants was $1,26,487.

Conclusion

The cost of care of a RTC victim is significant. In light of the high numbers of RTC victims admitted over the course of the year this is a significant cost burden for a regional hospital to bear. This cost must be taken into account when allocating hospital budgets.

Introduction

Road traffic crashes (RTCs) are the ninth leading cause of mortality and morbidity worldwide.¹ Developing countries suffer disproportionately from RTC related morbidity and mortality and more than 85% of the global deaths and injuries from RTCs occur in developing countries.² The UN 2003 report on the ‘Global road safety crisis’ stated that the economic impact of RTCs in developing countries is of major importance, yet many countries lack the data to calculate the costs of RTCs.³ This impedes attempts to evaluate the cost-effectiveness of prevention strategies and leads to a lack of understanding of the magnitude of the problem. In South Africa there were 14,920 fatalities and 2,19,978 non-fatal injuries caused by RTCs in 2007.¹ The World Health Organisation predicts that fatalities and injuries due to RTCs will increase over the next decade, most markedly in developing countries. This study attempts to cost RTC related injury using a bottom up micro-costing approach.

Class-approval for collection of data relating to trauma patients at our complex has been given by the Biomedical Research Ethics Committee of the University of Kwa-Zulu Natal (Reference BE207/09). Informed consent was acquired from all in-patients included in the study.

Section snippets

Methods

We conducted a prospective micro-costing study over a ten-week period during late 2011 and early 2012 at Edendale Hospital in Pietermaritzburg, South Africa. All patients who were admitted after a RTC were included in this study. Each patient was prospectively followed up, by the primary author. Injury details, demographics, investigations and interventions were recorded. Patients were reviewed every 48 h. All interventions (radiological investigations, blood tests, simple procedures (such as

Results

One hundred patients were admitted following a RTC over the ten weeks of the study. Forty-one were pedestrians (PVCs) and 59 were motor vehicle occupants (MVCs). Sixty-seven patients were between the ages of 15–44 years. On average patients spent 19 days in hospital. Table 1 summarises the patient demographics and the basic clinical details of the two groups. A total of 197 injuries were sustained by the one hundred patients. Twenty-six patients had three or more injuries. There was no

Discussion

There are two methods of calculating direct costs, the micro (bottom-up) and gross (top-down) approaches. Micro-costing involves recording and costing each component of a patient's care and summing them to obtain a total cost per patient. Gross costing takes the overall institutional cost and divides it by the number of patients treated to generate an average cost per patient. Due to the level of detail involved the micro-costing approach is regarded as the ‘gold standard’ for costing inpatient

Conclusion

The direct cost to the health system of road traffic crashes is considerable. This places a significant financial burden on any hospital treating large volumes of trauma patients. The major costs associated with the care of RTC victims must be taken into consideration when allocating hospital budgets. The figures we have generated with this study may be useful in larger population based costings of road traffic crashes. Data generated from such work may be useful in demonstrating the cost

Conflict of interest statement

None declared.

Funding

None received.

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The hospital cost of road traffic accidents at a South African regional trauma centre: A micro-costing study

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Conflict of interest statement

Funding

Burns

Road traffic accidents: hidden epidemic in less developed countries

J Natl Med Assoc

The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches

Health Econ

The epidemiology and cost of trauma to the orthopaedic department at a secondary level hospital

S Afr J Surg