Abstract
<h3>Research Objectives</h3> To understand how pre-injury health status present five-years preceding traumatic brain injury (TBI) affects direct medical cost two years post-injury. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Publicly funded healthcare system in Ontario, Canada. <h3>Participants</h3> Patients age 19 years or older in the emergency department (ED) or acute care for a TBI between April 1, 2007 and March 31, 2014 (N=55,669). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Direct medical costs within two years of discharge. <h3>Results</h3> Patients who received care in the ED (81.9% of total sample) incurred a median cost of $2,492/male patient (average $12,342/patient) and $3,508/female patient (average $12,372/patient) within two years of injury; 37 pre-injury factors were significantly associated with increased direct medical costs. Patients who first received care for their TBI in acute care (18.1%) incurred a median cost of $25,081/male patient (average $63,060/patient) and $30,277/female patient (average $65,285/patient) within two years of injury; 21 factors were significantly associated with increased direct medical costs. Among more prevalent factors, those associated with increased medical cost by at least 50% included mental health disorders, substance abuse, disorders or medical conditions frequently observed among the elderly, cardiovascular disorders, stroke and emergencies involving the brain, metabolic disorders and abdominal symptoms, conditions and symptoms of abdomen and pelvis, genitourinary disorders and disorders of prostate, and pulmonary abdominal and other emergencies. <h3>Conclusions</h3> Direct medical costs two years post-TBI differed significantly between patients with and without adverse pre-existing health status. Interdisciplinary teams to promote early identification of pre-existing health conditions and appropriate management and integration of these conditions in TBI care across the continuum of healthcare may be opportunities to reduce direct medical costs post-injury. <h3>Author(s) Disclosures</h3> None.
Highlights
Traumatic brain injury (TBI), defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force” [1], is a global public health concern
The comorbidities captured in these studies were primarily based on self-reports or included only a select number of health conditions based on comorbidity indices that were neither developed nor validated for the TBI population [4, 8, 9]
Even though it is well-established that the health experience and interactions with the health system differ between males and females with TBI [10,11,12,13,14], there is still a paucity of sex-stratified data to inform healthcare planning that is sensitive to the needs of male and female patients
Summary
Traumatic brain injury (TBI), defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force” [1], is a global public health concern. The comorbidities captured in these studies were primarily based on self-reports or included only a select number of health conditions based on comorbidity indices that were neither developed nor validated for the TBI population [4, 8, 9]. Even though it is well-established that the health experience and interactions with the health system differ between males and females with TBI [10,11,12,13,14], there is still a paucity of sex-stratified data to inform healthcare planning that is sensitive to the needs of male and female patients, . It is crucial to understand how pre-existing health status, defined as comorbid health conditions and personal, social, and environmental factors, affects direct medical cost after TBI to inform cost-effective healthcare planning and resource allocation at the health system level
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