A nursing care costing model for wound dressing in Nigeria

Abstract

Background: Wound dressing is a major component of wound management, and it is documented to consume huge healthcare resources in most countries. In Nigeria, the cost of wound dressing for an average wound care is unknown and it is borne almost entirely by the patients as most do not have health insurance coverage. This study examined the economic burden of wound dressing among inpatients and outpatients in an acute care episode. Purpose of the study: The purpose of the study was to develop a costing model to capture cost implications of wound dressing and hospitalization in order to contribute to the knowledge gap regarding the cost of wound dressing in Nigeria. Method: The investigator examined the cost of wound dressing materials, consumables, lotion used and hospitalization incurred by patients during a minimum of four weeks acute care episode. A descriptive cross-sectional design was adopted. The study was carried out in three Teaching Hospitals South West Nigeria. The study centres were purposively selected while the respondents (n= 320: Inpatients-190, Outpatients-130) were selected via a convenient sampling technique from wards and clinics where wound dressings were performed. Every patient who had spent not less than four weeks on the ward or who were discharged or on clinic visits were interviewed. Variables of interest included: frequency of wound dressing per week, number of dressing packs used per week, cost of dressing pack, cost of consumables, cost of lotion used, cost of hospitalization, occupation, monthly income, family size and health insurance coverage. The data was entered into the Statistical Package for Social Sciences (SPSS) version 23 and analyzed by descriptive and chi-square statistics while modelling cost of wound dressing and hospitalization was done by regression model analysis at 0.05 level of significance. The results were presented in a frequency table, percentages, mean and standard deviation. 1USD= ₦515, 1ZAR= ₦45- August 2021 Results: Phase I: Inpatients cost of wound dressing According to the study findings, the average age of the respondents was 44.95 ±16.12. Two thirds of the men were artisans and traders who had completed at least high school. Over 70% of respondents have a family size of 5 to 10 and more than half earn less than ₦50000 each month. The majority (79.5%) had no comorbidities and about half (50%) were on daily dressing, which required 1-5 moderate or major dressing packs per week. Most respondents (85.3 %) had a hospital stay of less than 11 weeks. Almost all the respondents were not on health coverage (90.5%). The cost of wound dressing varies every week and per acute care episode, depending on the wound type: The average cost of wound dressing per week ranges from ₦9000 to ₦27000, with burn injury dressing costing the most (₦26,783.33). Other wound dressing costs include ₦13,919.31 for an open wound, ₦13,870 for a pressure injury, ₦12,632.50 for diabetic foot ulcers, ₦10,867.87 for a surgical wound, ₦10,717.22 for a leg ulcer, and 9,473.04 for a cancer wound. The average cost of wound dressing per acute care episode was discovered to be between ₦5000 and ₦120000. The average cost of wound dressing per acute care episode for open wounds, pressure injuries, burn injuries, surgical wounds, leg ulcers, cancer wounds, and diabetic foot ulcers was ₦119,802.759; ₦110.546.667; ₦107,331.333; ₦89,501.463; ₦70,413.33; ₦67,874.783 and ₦50,350, respectively, according to differential cost per wound type. Furthermore, the cost of hospitalization per acute care episode ranges from ₦40000 to ₦178000, with the differential cost of hospitalization per acute care episode by wound type ranging from ₦177,333.33; ₦152,617.07; ₦150.717.24 and ₦120,866.67 for burn injury, surgical wound, open wound, and leg ulcer, respectively. Phase II: Outpatients cost of wound dressing: According to the study findings, the average age of the respondents was 43.03 ± 15.47. The population of both sexes was roughly the same (males accounted for 53.1%, females accounted for 46.9%). Most of the respondents were artisans and traders who had completed at least secondary school. The majority (72.3%) had a monthly income of less than ₦50000, with over 60% having a household size of 5 to 10. The most common wound aetiology was road traffic accident (34.6%), while the most common wound type was a leg ulcer (40%). The vast majority are free of comorbidities (82.3%). Furthermore, 40% of the participants were on wound dressing three times per week. In addition, over 60% of patients required a moderate dressing pack at each visit. Almost all of the participants who responded did not have health insurance (90.8%). The cost of wound dressing varies by wound type and outpatient care episode per week: wound dressing costs range from ₦3000-₦10000 per week, with costs for burn wounds, open wounds, and leg ulcers totalling ₦10048, ₦9452, and ₦9272.88, respectively. Apart from the cost of other expenses during a wound care episode, the cost of wound dressing per care episode ranges from ₦30000 to ₦160000. Phase III: Modelling cost of wound dressing and hospitalization The cost of wound dressing among hospitalized patients is estimated to be ₦54909.36 per acute care episode, with no contribution from other variables. The cost of wound dressing differed depending on the wound type, with a parameter estimate of ₦521801.92 for an open wound, ₦140885.20 for a surgical wound, and ₦332271.98 for a cancer wound. In addition, without accounting for other variables, the projected cost of hospitalization per acute care episode for all types of wounds was found to be ₦144693.65. The cost of hospitalization differed depending on the wound type, with a parameter estimate of ₦11830.10 for an open wound, ₦67694.90 for a surgical wound, and ₦26065.44 for a cancer wound. Similarly, the cost of wound dressing is estimated to be ₦176109.48 per care episode among outpatients, with no contribution from other variables. The parameter estimate for the differential cost of wound dressing per wound type was ₦28847.94 for an open wound, ₦33772.33 for a surgical wound, ₦267751.14 for a leg ulcer, ₦102640.00 for a diabetic foot ulcer, and ₦390328.72 for a cancer wound. Conclusion: For average Nigerians who are not registered in a health insurance program, the expense of wound care and hospitalization is prohibitively expensive. Essentially, a nursing care costing model for wound dressing and hospitalization was designed to aid individuals with wounds, hospital management, and health insurance companies in the design of healthcare finance. Nurses are additionally encouraged to deliver efficient and effective wound care since patients are paying out of limited resources. This will demonstrate how nurses contribute to the overall care of patients.