Page 106 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
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Chapter 4
Healthcare consumption & in-hospital costs
The costs related to admission and surgical intervention cost categories appeared to be the most important contributors to the reported in-hospital costs. In literature, costs related to ICU admission were also high and in-hospital costs also increased with higher injury and TBI severity (defined by GCS), ICP monitoring and surgical intervention. 36-40 The surprisingly lower LOS and in-hospital costs for elderly patients in this study could be explained by the fact that only 33.8% of elderly patients was classified as severe, compared to 62.8% of patients younger than 65.
Overall, the reported healthcare consumption and in-hospital costs seem to be quite similar to literature. 38,40,41 However, comparison was difficult due to substantial methodological variation and often inadequate methodology of available TBI cost studies. 19,20 The detailed calculation of healthcare consumption and in-hospital costs is an important strength of this study. The electronic patient file setup reduced the risk to a minimum that unregistered activities contributed to an underestimation of in-hospital resource utilization. Still, the numbers in this study are an enormous underestimation of the total healthcare consumption and total costs associated with t-ASDH and TBI, because the majority of costs are indirect and arise after hospital discharge. 40,42,43 Also, interpretation and generalization of the results should be done carefully since included patients represent a specific selection of patients with a t-ASDH with a suspected higher vulnerability, where patients with a concomitant hematoma requiring surgical intervention were excluded. Also, the inevitable presence of coexisting injuries causes that results are not solely attributable to TBI.
Despite these remarks, the reported costs give rise to the question whether or not the in-hospital costs may be justified by the achieved outcome. The mean in-hospital costs per patient appear to be acceptable for all TBI severity groups. However, when adding up the in-hospital costs that are made to have one patient achieve a favourable outcome, especially the most severely injured patients appear to be expensive. Unfortunately, true cost-effectiveness could not be established in this study and because there is no consensus in literature, additional research is needed to establish cost-effectiveness and justification of expenses in TBI care. 44-47
Future perspective
Future research should establish long-term outcome of ASDH patients after different treatment strategies. A high-quality cost-effectiveness research should incorporate
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