Page 79 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Cost data source
NP: “were available”
Obtained
from literature
and Medicare reimbursement rates
Hospital revenue department, finance department and financial reports
Unsubsidized total hospital billings
Most costs taken from official journal of the federation. Medicine price catalog, ICP probe price provided by supplier.
Details on cost calculation
Charges converted to costs using hospital based CCR
Cost calculations follow general principles earlier described in literature and methods section
Micro- and macro- costing methods. Activity units multiplied by unit costs
NP, most likely directly obtained from hospital billings
Amount
of supplies multiplied by unit price
Included costs
Hospitalization costs
Direct acute medical care costs, primarily associated with the initial hospitalization
Total cost of treatment (including hospitalization, surgery and investigations)
Total acute hospitalization treatment costs
Costs of hospitalization (direct medical costs + clinical complications) medicines, laboratory, imaging, surgery, LOS ICU/Ward.
Currency (Y) / GDP per capita b
Results ($ 2015) c
(% of GDP per capita)
Review on in-hospital costs after severe traumatic brain injury
US$ (1998) / - Survivors (GCS 5.4±1.9): $12,247 $45,866 (27%) ($2,199-$127,555)
- Non-survivors (GCS 3.4±0.8): $7,081 (15%) ($2,305-$32,622)
US$ (2011) / - Comfort care: GOS1: $60,582 3 $52,910 (115%) GOS2-3: $111,067 (210%)
GOS4-5: $43,753 (83%)
- Routine care: GOS 1: $77,410
(146%) GOS 2-3: $136,309 (258%)
GOS4-5: $52,167 (99%)
- Aggressivecare:GOS1-5:$124,725
(236%)
US$ (2016) / - GCS3-8: $8,964 (95%) ± $5,753
$9,416
US$ (2004) / - GCS3-8: median $3,115 (168%) $1,859 ($1,468 - $6,046)
- Isolated TBI: $2,844 (153%) - TBI with other injury: $3,207
(173%)
Mex$ (2015) - ICP monitoring group (GCS
Quality of study methodology
The results of the quality assessment are presented in detail in S1 Table. Study quality was variable with an average total score of 71% and a range of 48% to 96%. Seven studies achieved a score above 80%, representing “high quality”. 36,38,39,47,50,53,58 Especially items in the ‘cost data’ subgroup scored poorly (49%). All but one study mentioned their cost data source, but a clear description was missing in 24%. Also, the design and methods of costs analysis were not mentioned in 36% and were unclear in another 16%. Eleven studies properly assessed hospital activity data but only three studies appropriately valued and reported unit costs. Hospital costs were disaggregated in 20% of studies and in 52% charges were reported instead of costs. Major assumptions were tested in a sensitivity analysis in only 16% and a reference year was missing in 14% of the studies. The subgroups ‘study details’, ‘population’ and ‘methodology’
/ $9,291
5.5±1.7): $66,263 (713%) ± $31,436 - Control group (GCS 7.0±1.5):
$41,783 (450%) ± $10,622
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