Page 85 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Review on in-hospital costs after severe traumatic brain injury
cost research, but is very common in general TBI research and likewise complicates comparability, generalizability and interpretation of other studies. 79-82
Study quality also influenced interpretation of study results, since poor methodological
quality compromises quality and therefore value of data. Two recent reviews specifically
assessed the methodological quality of TBI cost evaluation studies and identified 3 important limitations regarding the adherence to the methodological principles of
economic evaluations. 7,10 More specifically, these limitations include not reporting
all relevant costs on a long-term or lifetime horizon, not discounting future costs, not
performing incremental analysis of cost-effectiveness and applying sensitivity analysis.
Our quality assessment found variable and overall inadequate study quality. Only few
studies were considered high quality and especially items concerning the calculation
and reporting of costs scored poorly. Cost results were often provided without relevant
context. A description of costs analysis methods, required to understand and interpret
the results, was frequently missing. Studies also rarely calculated in-hospital costs by transparently multiplying healthcare consumption with associated unit costs. Almost
no study reported the highly informative and important disaggregated costs. Even
reference years were missing in several studies. Because several studies did not focus
on reporting costs after TBI, they might have scored low on our quality assessment,
despite appropriately investigating their specific study objectives.
Strengths and limitations
This systematic review benefits from an extensive literature search in multiple databases and strict inclusion criteria, which improve study comparability and interpretation of results. The PRISMA guidelines were used during the review process and the quality assessment made use of a checklist that was based on the CHEERS statement and allowed the critical appraisal of the included articles. Although the assignment of scores is partly subjective, our experiences regarding the quality assessment using this checklist were positive. In addition, this is by our knowledge, the first detailed overview of in-hospital costs in patients with s-TBI.
This study also has several limitations. The article selection criteria resulted in the exclusion of some patients, that were severely injured but lacked the required severity classification. Also, regarding in-hospital costs, studies were excluded that not clearly distinguished acute care in-hospital costs from rehabilitation costs, indirect costs or other non in-hospital costs. Data from these patients could have contributed to our results, but the introduction of additional methodological and clinical heterogeneity
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