Page 75 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Cost data source
Hospitalaccounting database
Finance and billing department of (trauma) hospital and university
Expected costs calculated from a reimbursement system using diagnosis related groups (DRG)
Charges are obtained directly from all service providers
Costs are estimated from financial records of the health maintenance organization (HMO)
Trauma registry and individual chart review
National Inpatient Sample (NIS) database (1993-1994/ 2006-2007)
Total charged amounts most likely from hospitals, CCR from HCUP-KID or institution’s billing office
All treatment costs measured using budget information
Details on cost calculation
NP,mostlikely directly obtained from database
NP, most likely directly obtained from database
DRG reimbursement multiplied by the DRG cost weight for each patient
Services and billing records were added up to calculate actual/ estimated charges
Unit costs are multiplied by utilized services
NP, most likely directly obtained from registry of charts
NP, most likely directly obtained from database
Obtained charges converted to costs with institution specific cost- charge ratio (CCR)
Macro and micro costing approach
Included costs
Currency (Y) / GDP per capita b
Results ($ 2015) c
(% of GDP per capita)
Review on in-hospital costs after severe traumatic brain injury
Totalhospital US$(NP)/ - ET(GCS4.3±1.9):median$348,858 charges $52,876 (660%)
(95% CI: $293,682-$468,908)
- LT(GCS4.5±1.8):median$396,917
(751%) 3 (95% CI: $334,441-$520,808)
Hospital and US$ (2012) / - GCS <9: $58,899 (110%) ± $74,194 physician $53,681 - AIS 4: $37,503 (70%) ± $58,025 charges. (Cost- - AIS ≥5: $59,146 (110%) ± $87,230 to-charge ratio:
140.65%).
Total acute NOK (2009) - All: $112,808 (128%) ± $68,327
hospitalization / $87,894 - Trajectory 1: $123,526 (141%) ± costs for first 5 $50,911
years post-injury - Trajectory 2: $101,822 (116%) ±
$81,725
Initial care US$ (1993) / - Acute care: $123,303 (307%)
charges $40,211 - Physicians: $25,767 (64%) including EMS, - Emergency Medical Services acute care (EMS): $1,855 (5%)
charges and
physicians charges of initial hospitalization
Acute medical US$ (NP) / - All: $24,205 (60%) care costs $40,211
using actual
operational
costs.
Total charges US$ (1997) / - 1991-1994 (GCS 4.0): $51,634
(hospital $44,428 (116%)
room, critical - 1995-1996 (GCS 3.5): $42,558 care, nursing (96%)
services, direct - 1997-2000 (GCS 3.5): $40,002 and indirect (90%)
expenses,
general hospital
charges)
Total charges of US$ (2006- - 1993-1994: $21,427 ± $21,315 hospitalization 2007) / - corrected for inflation: $29,999
$53,764 (56%)
- 2006-2007: $65,002 (121%) ±
$60,900
Total costs of US$ (2012) / - Hospital mean: $106,969 (199%) hospitalization $53,681 (95% CI: $96,355 - $117,582)
+ ICU care - ICU mean: $84,843 (156%)
(95%CI: $76,364 - $93,322) Only direct US$ (2002) / - Group 1 (GCS median 5.5, IQR
provider costs calculated during admission
$5,379
2.0): $10,356 ± $6,526 (121%)
- Group 2 (GCS median 6.0, IQR 2.0): $11,646 ± $8,168 (152%)
73