title: Return to work after specialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs.
abstract: BACKGROUND
  Burn injuries may cause long-term disability and work absence, and therefore result in high healthcare and productivity costs. Up to now, detailed information on return to work (RTW) and productivity costs after burns is lacking.
  
  
  OBJECTIVE
  The aim of this study was to accurately assess RTW after burn injuries, to identify predictors of absenteeism and to calculate healthcare and productivity costs from a societal perspective.
  
  
  METHODS
  A prospective cohort study was conducted in the burn centre of Rotterdam, the Netherlands, including all admitted working-age patients from 1 August 2011 to 31 July 2012. At 3, 12 and 24 months post-burn, patients were sent a questionnaire: including the Work and Medical Consumption questionnaire for the assessment of work absence and medical consumption and the EQ-5D-3L plus a cognitive dimension to assess post-burn and pre-burn quality of life (QOL). Cost analyses were from a societal perspective according the micro-costing method and the friction cost method was applied for the calculation of productivity loss. Univariate logistic regression was used to identify predictors of absenteeism at three months.
  
  
  RESULTS
  A total of 104 patients were included in the study with a mean total body surface area (TBSA) burned of 8% (median 4%). 66 respondents were pre-employed, at 3 months 70% was back at work, at 12 months 92% and 8% had not returned to work at time of final follow-up at 24 months. Predictors of absenteeism at 3 months were: TBSA, length of stay, ICU-admission and surgery. Mean costs related to loss in productivity were €11.916 [95% CI 8.930-14.902] and accounted for 30% of total costs in pre-employed respondents in the first two years.
  
  
  CONCLUSIONS
  This two-year follow-up study demonstrates that burn injuries cause substantial and prolonged productivity loss amongst burn survivors with mixed burn severity. This absenteeism contributes to already high societal costs of burn injuries. Predictors of absenteeism found in this study were primarily fixed patient and treatment related factors, future studies should focus on modifiable factors, in order to improve RTW outcomes. Also, more attention in the rehabilitation trajectory is needed to optimally support RTW in burn survivors.
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: goeih@maasstadziekenhuis.nl.
authors.forename: H
authors.initials: H
authors.lastname: Goei
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hop
authors.affiliation: Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vlies
authors.affiliation: Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands.
authors.forename: M K
authors.initials: MK
authors.lastname: Nieuwenhuis
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: baarm@maasstadziekenhuis.nl.
authors.forename: M E
authors.initials: ME
authors.lastname: van Baar
mesh_terms: D000041:Absenteeism; D000328:Adult; D017677:Age Distribution; D002053:Burn Units; D002056:Burns / Q000191:economics* / Q000534:rehabilitation / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D062707:Return to Work / Q000191:economics* / Q000706:statistics & numerical data; D017678:Sex Distribution; D012923:Social Class; D017741:Survivors; D014945:Wound Healing
keywords: Burns; Cost analysis; Productivity loss; Rehabilitation; Return to work