Cost of medical care for a population-based sample of persons surviving traumatic brain injury

Brooks, Christian; Lindstrom, Jennifer H.; McCray, Jeannie; Whiteneck, Gale G.

doi:10.1097/00001199-199508000-00002

Cited by 37 publications

(21 citation statements)

References 1 publication

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“…This figure is small in comparison with the acute medical and lifetime care costs arising from severe traumatic brain injury; indeed, in 1995 Brooks et al 28 estimated the medical costs alone over the first 4 years after injury to be in excess of £100 000 (figure converted from $US). If the two point criterion change on the BICRO-39 is taken as a clinically meaningful gain-that is, one which represents a marked improvement in a patient's independence and quality of life and which potentially reduces the burden on carers and society, then there may well be longer term savings in future care costs or provision of state benefits to these clients and their families; however, a study with a much longer follow up period would be needed to determine the long term economic impact.…”

Section: Discussionmentioning

confidence: 97%

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial

Powell

Heslin

Greenwood

2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

221

158

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Objective: Evaluation of multidisciplinary community based outreach rehabilitation after severe traumatic brain injury (TBI). Methods: A randomised controlled trial compared outreach treatment (mean of two sessions a week for 27.3 (SD 19.1) weeks) in community settings such as participants' homes, day centres, or workplaces, with provision of written information detailing alternative resources. Follow up for an average of 24.8 months after initial allocation was by a blinded independent assessor. Participants were aged 16-65, had sustained severe TBI between 3 months and 20 years previously, and had no other neurological conditions. Of 110 initially allocated, 48 outreach and 46 information participants were successfully followed up. Primary outcome measures (Barthel index (BI) and the brain injury community rehabilitation outcome-39 (BICRO-39)) focused on levels of activity and participation. Secondary measures were the functional independence measure and the functional assessment measure (FIM+FAM) and, in a subgroup of 46 participants, the hospital anxiety and depression scale. Analyses were non-parametric. Results: outreach participants were significantly more likely to show gains on the BI and the BICRO-39 total score and self organisation and psychological wellbeing subscales. There were likewise strong trends (p<0.10) for BICRO personal care and mobility, and on the FIM+FAM for personal care and cognitive functions. Differential improvements were not seen for indices of socialising, productive employment, anxiety, or depression. Median changes on individual subscales were small, reflecting the diversity of the clinical population; however, 40% of outreach but only 20% of information participants made a clinically significant improvement of 2+ points on at least one BICRO-39 scale. Time since injury was unrelated to the magnitude of gains. Conclusions: This is the first RCT of multidisciplinary community rehabilitation after severe TBI, and suggests that even years after injury it can yield benefits which outlive the active treatment period.

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Section: Discussionmentioning

confidence: 97%

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial

Powell

Heslin

Greenwood

2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

221

158

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“…Significant attention has been devoted to estimating costs of TBI but this literature is subject to a number of limitations. In particular many studies examine only a subset of TBI patients such as patients with a specific level of injury severity [17,18] occupation type [19] or a specific age [20]. Other findings are based on a small non-representative sample of patients [10 11 20] and the authors use the incidence rates to project sample-based cost estimates to the entire population.…”

Section: Introductionmentioning

confidence: 99%

Direct cost associated with acquired brain injury in Ontario

et al. 2012

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BackgroundAcquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada.MethodsA population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer’s perspective.ResultsDirect medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components.ConclusionsThe main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.

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“…Max and colleagues calculated that annual direct and indirect costs of TBI were $44 billion in 1988 dollars [7]. Brooks and co-workers found that acute care costs ranged from $10 990 for mild injuries to $81 152 for severe injuries [8]. The cost of rehabilitation of the severe TBI patient has been found to range from $35 000 [9] to $110 000 [10] per case.…”

Section: Epidemiologymentioning

confidence: 99%

Outcome from traumatic brain injury

Jallo¹,

Shutter²

1998

Trauma Quarterly

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Traumatic brain injury (TBI) continues to be a significant public health issue. Advances in acute medical care after brain injury have improved mortality, but the morbidity from residual neurological deficits remains high. Multiple variables have been shown to have an impact on the outcome from TBI and, although many of these factors are not modifiable, a number of them can be influenced by medical interventions. Multidimensional assessments of the early clinical findings can provide some predictions regarding the potential for recovery after TBI. In addition, an awareness of the modifiable factors may assist with the prevention of secondary injury and optimization of the long-term outcome. Certain neurodiagnostic studies can be used to supplement the patients' physical findings and help guide medical management. Finally, rehabilitation services have documented benefit in the TBI population and are being initiated earlier in the course of medical care. This article attempts to review many of these variables and provide information on the clinical outcomes following TBI.

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Cost of medical care for a population-based sample of persons surviving traumatic brain injury

Cited by 37 publications

References 1 publication

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial

Direct cost associated with acquired brain injury in Ontario

Outcome from traumatic brain injury

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