Page 128 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 5
TBI patients that visited the ER but did not require hospitalisation were not included in this study. A precise calculation and comparison of costs was therefore not possible. Costs of these patients are expected to be substantially lower compared to admitted patients since important cost drivers (admission and surgery) are not applicable. Following the unit costs in Supplement 1 (ER, imaging, labs), the average costs are likely to be somewhere between €500 - €1.000. A reduction in number of admitted mild TBI patients, when safe and possible, might result in substantial cost savings, especially since its incidence is high.
The direct costs of TBI (all consumed resources within the health-care sector) are generally considered to be smaller than the indirect costs (loss of productivity and intangible costs). 2,78,79 Because of the focus on in-hospital costs, our study results dramatically underestimate the exact total costs related to TBI. 57,80,81 The reported in-hospital costs are also likely to be an underestimation, despite our accurate calculations. More accurate numbers could be achieved by using hospitals’ actual cost prices, rather than approximations from guidelines or governmental organizations. These numbers were unfortunately unavailable. Including an accurate complete cost overview is however essential for future cost-effectiveness studies. 66,80-82
Future TBI research initiatives should include the combination of long-term outcome and complete economic perspective, because this can improve the objectivity of future treatment decision-making. When striving for cost-effectiveness, people should however not forget the individual aspects of care and the social utility of providing care for severely injured patients. 83
CONCLUSIONS
Hospitalized TBI patients show substantial in-hospital healthcare consumption and high in-hospital costs, even in patients with mild TBI. These costs are likely to be an underestimation of the actual total costs after TBI. Although patients from all TBI severity categories were able to achieve full recovery, mortality and unfavourable outcome rates were high and increased with TBI severity, intracranial abnormalities, extracranial injury and surgical intervention. Future studies should focus on the long- term effectiveness of treatments in relation to a complete economic perspective.
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