Determinants of hospital costs associated with traumatic brain injury in England and Wales*

Abstract

SummaryUsing data from the Trauma Audit Research Network, we investigated the costs of acute care in patients ‡ 18 years of age hospitalised for traumatic brain injury between January 2000 and December 2005 in England and Wales. Traumatic brain injury patients were defined and stratified using the Abbreviated Injury Scale. A total of 6484 traumatic brain injury patients were identified; 22.3% had an Abbreviated Injury Scale score of three, 38.0% of four and 39.7% of five. Median age (IQR) was 42 years (28-59) and 76.7% were men. Primary cause of injury was motor vehicle collisions (42.4%) followed by falls (38.0%). In total 23.7% of the patients died before discharge. Hospitalisation costs averaged £15 462 (SD £16 844). Costs varied significantly by age, Glasgow Coma Score, Injury Severity Score, coexisting injuries of the thorax, spine and lower limb, hospital mortality, availability of neurosurgical services, and specialty of attendants seen in the Accident and Emergency department.

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

“…Previous observational studies, consistent with cost data in HITS-NS, suggest large incremental differences in costs between management in specialist and non-specialist centres. 3,41 Disparities of this magnitude are less likely to be explained by confounding, suggesting that our parameterisation may indeed reflect reality. However, ultimately, evidence from a well-conducted randomised trial is necessary to provide a definitive estimate.…”

“…Each patient with TBI costs an average of £15,000 for acute NHS care, a figure which increases if the patient is admitted to a SNC. 3 Subsequent rehabilitation costs are also significant, but both are dwarfed by costs to society from premature death or lifelong dependency as a young adult. Observational evidence at the time of applying for funding in 2008 suggested that this NHS investment had failed to reduce case fatality from TBI over the 1994-2003 decade, with recent trials of neuroprotective agents failing to identify any single new effective therapy.…”

“…The interventions include evacuation of intracranial haematoma [subdural haematoma (SDH), extradural haematoma (EDH)], establishment of ICP monitoring and resulting surgical interventions, such as ventriculostomy and decompressive craniectomy. To justify the feasibility analysis, we hypothesised that, should early neurosurgery be shown in a full trial to be cost-effective at absolute 30-day mortality and 6-month severe disability reduction of 5%, the extra costs to the NHS (£17M per annum 3 ) would be offset by the significant economic benefits of reduced morbidity in this young population, which can be estimated from a 5% reduction resulting in 450 fewer TBI deaths and severe disabilities per annum; the annual societal saving, given a conservative estimate of each TBI death or severe disability costing society £250,000 (J Nicholl, University of Sheffield, September 2011, personal communication), would be £117M (£100M after NHS costs) -this excludes the value of any legal settlements.…”

“…However, the model output appears to have face validity and is not inconsistent with costs and outcomes reported in other broadly related studies. 3,41,111 Finally, there are a number of potential limitations that could affect expected value of information results. These analyses are premised on the implemented decision analysis model and are therefore subject to identical biases arising from model inputs and structure described previously.…”

Management of Dysphagia Following Traumatic Brain Injury

“…In developed countries, the annual incidence rates are approximately 200 per 100,000 [1]. The greater the severity of TBI, the greater the economic burden on healthcare providers [2,3], particularly acute care and rehabilitation services.…”