Page 124 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 5
Figure 2. In-hospital healthcare consumption & in-hospital costs
Figure 2 shows the mean in-hospital costs for patients with TBI, specified per severity category and per cost
category to show their contribution to the total in-hospital costs.
In-hospital costs
Mean in-hospital costs were €11,918. €7,896 was related to admission (66%), € 1,493 to surgery (13%), and € 1,042 to other (9%). (Table 2) Costs related to radiology (7%) and laboratory (5%) were smaller contributors. Average in-hospital costs were € 7,795 for mild, €20,207 for moderate € 26,595 for severe, and € 26,349 for very severe TBI patients. (Figure 2) Presence of intracranial abnormalities on the first CT-scan nearly doubled total in-hospital costs (€ 15,783 vs. € 8,238). Intracranial surgery or ICP monitoring quadrupled the costs (respectively € 36,866 vs. € 7,928 and € 47,255 vs. € 8,748). Patients with a decompressive craniectomy (€ 49,754), ‘regular’ craniotomy (€ 33,195) or extracranial surgery (€ 19,957) were also more expensive compared to non-surgically treated patients. Patients with a 6-month GOSE score of 8 showed the lowest in-hospital costs of € 5,774, while patients with a GOSE score of 2/3 showed costs of € 36,190.
DISCUSSION
The current study found substantial in-hospital healthcare consumption and high in- hospital costs for hospitalized TBI patients, even after mild TBI. Both length of stay and in-hospital costs increased with TBI severity and presence of intracranial abnormalities and extracranial injuries. The most important cost drivers were admission and surgical intervention. Patients from all TBI severity categories were able to achieve full recovery, even after sustaining very severe TBI. Nonetheless, mortality and unfavourable outcome rates were high and the majority of patients reported remaining deficits or disabilities after 6 months.
122