Page 69 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Review on in-hospital costs after severe traumatic brain injury
INTRODUCTION
Healthcare expenditures are rising worldwide and endanger the affordability of
national healthcare systems. 1,2 To secure their future existence, a thoughtful and
righteous distribution of limited resources is essential. Policy makers and healthcare professionals are therefore increasingly expected to study the effectiveness of 3 treatments and its associated costs. 3,4 After all, the input from high quality cost
research is required to make healthcare systems efficient and to achieve the highest quality of care for the lowest costs. 5
Also in the field of traumatic brain injury (TBI), with an estimated total global annual burden of US$ 400 billion, research efforts are increasingly conducted towards cost- effectiveness. 6-10 After sustaining a TBI, in-hospital treatment is frequently required and generally associated with high costs. 11-14 In the USA, the 2010 TBI-related in- hospital charges totalled US$ 21.4 billion. 15 In-hospital costs after TBI are increasing annually and represent a substantial part of the total financial TBI burden. 15 The highest individual costs in TBI patients are generally seen in patients with severe TBI (s-TBI). 16 These patients also have the longest hospital or intensive care unit (ICU) length of stay (LOS) and the highest number of (neuro)surgical and medical interventions. 16-18 Despite their substantial healthcare consumption, these vulnerable patients show high rates of mortality and unfavourable outcome. Especially for these patients with poor outcome at high costs, a critical appraisal of treatment cost-effectiveness is essential to avoid ineffective expenditures and improve treatment decision-making. 19-22
Two recent reviews on healthcare costs after TBI have reported about the considerable variation in healthcare costs after TBI between different studies and about the insufficient quality of the available cost studies.7,10 These reviews however were mainly focussed on the methodological quality of economic evaluations and therefore did not report the actual in-hospital costs. Insight into in-hospital costs and important components of the costs, such as healthcare utilization and other factors that drive these costs were not provided. This is important information for physicians and policymakers, because this information is needed for decision-making and for correct allocation of resources.
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