A Narrative Review on Financial Challenges and Health Care Costs Associated with Traumatic Brain Injury in the United States

Abstract

Traumatic Brain Injury (TBI) is a highly prevalent and potentially severe medical condition. Challenges regarding TBI management are related to accurate diagnostics, defining its severity and establishing prompt interventions in order to impact outcomes. Among the healthcare components in TBI handling strategy is intracranial pressure (ICP) monitoring, which is fundamental to therapy decisions. However, ICP monitoring is an Aquiles tendon, imposing a significant financial burden on healthcare systems, particularly in middle and low-income communities. This review primarily investigates the economic burden of TBI and whether new technologies are suitable to reduce its healthcare costs without compromising the quality of care, according to the levels of evidence available MATERIAL AND METHODS: For this narrative review, the authors conducted a PUBMED search for articles discussing TBI healthcare costs, as well as monitoring technologies (tomography, magnetic resonance imaging, optic nerve sheath diameter, transcranial Doppler, pupillometry and noninvasive ICP waveform) and their application in managing TBI. Strategies were first evaluated from a medical noninferiority perspective before calculating the average savings of each selected strategy. All applicable papers were analyzed for quality using the Consolidated Health Economic Evaluation Reporting Standards 2022 Statement (CHEERS 2022)117 and the paper was written to conform as much as possible with it. The review included a total of 109 references and revealed a consistent potential in noninvasive technologies to reduce costs while maintaining or improving the quality of care. TBI prevalence has grown with an unproportionate healthcare burden in the last decades. Noninvasive monitoring techniques seem to be effective to reduce TBI healthcare costs, with no neglectable limitations, especially the need for more supporting scientific evidence. The clinical and financial undeniable potential of these techniques are compelling to further investigate their role in TBI management, as well as the creation of more comprehensive monitoring models to the understanding of complex phenomena occurring in the injured brain.