Cost Analysis of Maxillofacial Trauma Treatment in Three Major Ministry of Health Malaysia Hospitals

Background: Maxillofacial trauma imposes a considerable burden on healthcare systems. The Facial Injury Severity Scale (FISS) may help to estimate treatment complexity and healthcare resource requirements. However, evidence regarding its relationship with treatment costs and resource utilization in Malaysian public hospitals remains limited. Objective: To evaluate the relationship between FISS scores, treatment costs, and healthcare resource utilization among maxillofacial trauma patients treated in Ministry of Health Malaysia (MOH) hospitals. Materials and Methods: A retrospective multicenter cohort study included 132 adult patients who underwent open reduction and internal fixation (ORIF) for maxillofacial fractures between January and December 2022 in 3 MOH hospitals. FISS scores were characterized as low (1–5), moderate (6–10), and high (>10) severity groups. Healthcare resource utilization was assessed using operating theatre (OT) duration, length of stay (LOS), and treatment cost. Treatment costs were estimated from the healthcare provider's perspective using a combination of activity-based and top-down costing approaches. Unadjusted differences across FISS groups were evaluated, and multivariable-adjusted general linear models were used to examine associations between FISS severity groups and each outcome after adjustment for age, gender, Glasgow Coma Scale (GCS), study site, and injury-to-OT time. Results: Increasing FISS severity was associated with significantly longer OT duration (118 versus 135 versus 162 min; P <0.001), prolonged LOS (4 d versus 4 d versus 9 d; P =0.048), and higher treatment costs (RM 6564.47 versus RM 8065.28 versus RM 9830.90; P =0.003). After adjustment for age, gender, GCS, study site, and injury-to-OT time, significant differences across FISS categories remained for OT duration ( P =0.001) and treatment cost ( P =0.001), whereas the association with LOS was no longer statistically significant ( P =0.201). Adjusted mean OT duration increased from 145.42 minutes in the low-FISS group to 220.94 minutes in the high-FISS group, while adjusted mean treatment cost increased from RM 7158.23 to RM 9552.91. The mean treatment cost per patient was RM 7592.43 ± 2364.14 (USD 1807.72 ± 562.89). Plating and screw costs (28.97%) and personnel costs (20.44%) were the largest contributors to treatment expenditure, while the operating theatre accounted for 60.18% of the total cost. Conclusion: Higher FISS scores were associated with greater healthcare resource utilization and treatment costs among maxillofacial trauma patients treated in MOH hospitals. After adjustment for relevant and institutional factors, higher FISS severity remained significantly associated with longer operative duration and higher treatment cost, whereas the association with LOS was attenuated. These findings support the potential use of FISS as a practical indicator of operative resource requirements and treatment expenditure in maxillofacial trauma care.