Page 83 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Review on in-hospital costs after severe traumatic brain injury
DISCUSSION
This systematic review demonstrates that the in-hospital costs related to acute care for
patients with s-TBI are generally high and increase with severity of TBI and overall severity of
the injury. Both healthcare consumption and in-hospital costs are highly variable between
studies and associated with factors such as mechanism of injury and treatment strategy. 3
Three previous reviews on costs after TBI were generally in line with our results, but results were difficult to compare with the present review due to differences in study objectives and substantial variation between the included studies that was mainly caused by differing methodological and clinical characteristics. 7,59,60 Elaborating on these reviews, we specifically investigated the in-hospital costs related to acute care for patients with s-TBI aiming to reduce variation and improve study comparability. Methodological and clinical heterogeneity remained present, likely contributing to the variation in in-hospital costs between studies. The highest in-hospital costs were found in studies from the USA that reported charges instead of costs. Because hospital charges are not actual costs and usually higher than hospital costs, this increased total amounts. Charges are also often non-transparent and the resultant of deals between hospitals and insurance companies or other stakeholders. It is therefore preferred to calculate and report total costs by using healthcare utilization with its corresponding unit costs. Also, USA healthcare expenditures are twice as high as expenditures in other high-income countries. 2,61 While healthcare utilization patterns were rather similar between high-income countries, the higher expenditures were especially caused by higher prices of labour, goods, pharmaceuticals and administrative costs. 2,62 Large international differences were also seen between European countries when assessing injury related hospitalization costs. 63 Likewise, the lowest in-hospital costs were found in studies from lower-income countries, which is also in accordance with literature. 64 These absolute costs are lower because of lower prices, lower treatment intensity and higher mortality rates with associated lower resource utilization. 64,65 In-hospital costs reported as percentage of GDP per capita were however not significantly different between high and low income countries, suggesting a similar financial impact for patients. Differences in costs might also be caused by hospital associated factors (e.g. level of trauma center, volume, treatment protocols) and by the major epidemiological differences of trauma populations between countries. 6 The different timeframes included in this review could also contribute to variation, since treatment strategies have changed over time and healthcare costs have been increasing globally over the years. 15,64,66 Comparing in-hospital costs from different healthcare systems in different timeframes is therefore problematic.
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