Page 103 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Outcome versus in-hospital costs: a neurosurgical paradox?
Healthcare Costs
Mean in-hospital costs were € 24,980 per patient and primarily the result of costs
related to admission (€ 14,980) and surgical intervention (€ 6,890). Mean in-hospital
costs were significantly higher for vs-TBI (€ 30,230), s-TBI (€ 29,660) and moderate TBI
(€ 27,650) subgroups compared to the mild TBI (€ 17,980) subgroup (P<0.05) (Table
3). For these severity subgroups, mean costs specifically related to ICU admission
were € 13,230, € 13,150, € 7,550 and € 5,460 respectively (Figure 2). Patients’ healthcare
utilization were more expensive after surgical intervention than conservative treatment
(€ 28,670 vs. € 6,520). Patients with a decompressive craniectomy showed the highest 4 cost specifically related to surgery. Patients with additional ICP monitoring (€ 36,580)
showed highest total costs, of which 64% was related to admission. A lower initial GCS and pupillary abnormalities show an increase in patient LOS and in-hospital costs, except for patients with a GCS of 3. Other characteristics associated with significantly increased total costs were: age < 65, a concomitant intracranial hematoma that not required surgical intervention, presence of pupillary abnormalities and unfavourable outcome.
Five patients (23%) from the vs-TBI subgroup achieved favourable outcome (GOS4-5) at mean in-hospital costs of € 132,610 per patient. Mean costs for patients achieving favourable outcome were € 103,790 for s-TBI patients (N=14; 29%), € 58,150 for moderate TBI patients (N=9; 47%) and € 24,800 per mild-TBI patient (N=29; 72%). Mean in-hospital costs were highest (€ 246,920) for one patient from the GCS=3 subgroup (N=10) that reached favourable outcome.
Figure 2. In-hospital costs
Fig.2 shows mean and total in-hospital costs for all patients and for severity subgroups. Also, a distinction has been made between investigated cost categories to show their share to the total in-hospital costs
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