Cost per case or total cost? The potential of prevention of hand injuries in young children - retrospective and prospective studies

Abstract

Background: Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996-2003.

Methods: Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed.

Results: Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days.

Conclusion: The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.

Figure 1

Annual median total health-care cost in EUR (left hand side scale) with 25^th and 75^th percentiles and number of ward days (right hand side scale) per patient 1996–2003.

Figure 2

Total cost (EUR) for hand and forearm injuries in 51 children from the Malmö catchment area for 12 months 2002–2003 by sources of cost (surgery, other health-care cost, including ward days; lost productivity when parents were absent from paid work due to the child's injury).

Figure 3

Box plot of health-care cost (EUR) by type of case, sorted by median cost. Seven case categories that closely corresponded to alternative prevention strategies were constructed: A) burn injuries caused by hot objects, B) fingertip injuries caused by jamming in doors or other pinch objects, C) fractures, dislocations and sprains caused by a fall or hit, D) tendon and nerve injuries and wounds caused by sharp objects, E) complex injuries (an injury to more than one of the anatomical components of the hand or total or subtotal amputation through the middle or proximal phalanges) caused by falls with sharp objects, F) complex injuries caused by machines and rifles, and G) other injuries.

Figure 4

Bar plot of health-care cost (EUR) by type of case, sorted by total costs for all patients. Seven case categories that closely corresponded to alternative prevention strategies were constructed: A) burn injuries caused by hot objects, B) fingertip injuries caused by jamming in doors or other pinch objects, C) fractures, dislocations and sprains caused by a fall or hit, D) tendon and nerve injuries and wounds caused by sharp objects, E) complex injuries (an injury to more than one of the anatomical components of the hand or total or subtotal amputation through the middle or proximal phalanges) caused by falls with sharp objects, F) complex injuries caused by machines and rifles, and G) other injuries.

Figure 5

Bar plot of distribution of time from injury to admittance by type of case sorted by percent admitted the same day, after one day and after two or more days. Seven case categories that closely corresponded to alternative prevention strategies were constructed: A) burn injuries caused by hot objects, B) fingertip injuries caused by jamming in doors or other pinch objects, C) fractures, dislocations and sprains caused by a fall or hit, D) tendon and nerve injuries and wounds caused by sharp objects, E) complex injuries (an injury to more than one of the anatomical components of the hand or total or subtotal amputation through the middle or proximal phalanges) caused by falls with sharp objects, F) complex injuries caused by machines and rifles and G) other injuries.