Page 237 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Cost-effectiveness aside, the average in-hospital costs of s-TBI patients (€26,595) 6 that would be associated with the proposed strategy seem to be acceptable compared to the in-hospital costs for other diseases in the Netherlands. Costs were lower compared to the in-hospital costs of s-TBI for patients with ischaemic stroke (€5.328) 117, transient ischaemic attack (€2.470) 117, appendicitis (€3.700), colorectal cancer (€9.777 – €19.417) 118, percutaneous coronary intervention (€14.037) or coronary artery bypass grafting (€17.506) 119. In-hospital costs were higher for patients with non-small cell lung cancer (€33.143) 120, ipilimumab treatment in melanoma patients (€73.739) 121 or patients receiving extracorporeal life support treatment (€106.263). 122
Costs also seem to be acceptable when comparing the in-hospital costs for s-TBI patients with the Dutch cut-off point for cost-effective treatments of €80.000 per Quality-adjusted Life Year (QALY). 123 Although the comparison of reported in-hospital costs with the €80.000 cut-off point for cost-effectiveness analyses is not entirely appropriate, and although there are always few patient outliers with very high costs, the costs of nearly every TBI patient studied in this thesis was lower than €80.000.
Both comparisons are illustrative, but have obvious limitations. First, analyses should not only assess in-hospital costs, but all costs associated with s-TBI, including out of hospital and other indirect costs. Only using in-hospital costs results in a major underestimation of the total costs related to s-TBI. Especially when patients survive with severe disabilities, chronic care after hospital discharge, but also loss of productivity, have substantial economic and societal impact.
Including an economic perspective in decision-making is regarded as reasonable because of its objectivity. Focusing on the economic perspective however also fails to recognize individual aspects of care and the social utility of caring for those most in need. People obtain benefit from the belief that they live in a compassionate and humane society where patients in need will not be ignored merely based on costs. Still, there must be a point where TBI is so severe and patient outcome so ‘unacceptable’ that it does not justify the associated costs. For future decision-making, it would be very helpful to know where that point is.
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General discussion and future perspectives
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