Research Reports - Medical care costs associated with traumatic brain injury over the full spectrum of disease

J Neurotrauma. 2012 Jul 20;29(11):2038-49

Leibson CL, Brown AW, Hall Long K, Ransom JE, Mandrekar J, Osler TM, Malec JF

Abstract Data on traumatic brain injury (TBI) economic outcomes are limited. We
used Rochester Epidemiology Project (REP) resources to estimate long-term medical
costs for clinically-confirmed incident TBI across the full range of severity
after controlling for pre-existing conditions and co-occurring injuries. All
Olmsted County, Minnesota, residents with diagnoses indicative of potential TBI
from 1985-2000 (n=46,114) were identified, and a random sample (n=7175) was
selected for medical record review to confirm case status, and to characterize as
definite (moderate/severe), probable (mild), or possible (symptomatic) TBI. For
each case, we identified one age- and sex-matched non-TBI control registered in
REP in the same year (±1 year) as case's TBI. Cases with co-occurring non-head
injuries were assessed for non-head-injury severity and assigned similar
non-head-injury-severity controls. The 1145 case/control pairs for 1988-2000 were
followed until earliest death/emigration of either member for medical costs 12
months before and up to 6 years after baseline (i.e., injury date for cases and
comparable dates for controls). Differences between case and control costs were
stratified by TBI severity, as defined by evidence of brain injury; comparisons
used Wilcoxon signed-rank plus multivariate modeling (adjusted for pre-baseline
characteristics). From baseline until 6 years, each TBI category exhibited
significant incremental costs. For definite and probable TBI, most incremental
costs occurred within the first 6 months; significant long-term incremental
medical costs were not apparent among 1-year survivors. By contrast, cost
differences between possible TBI cases and controls were not as great within the
first 6 months, but were substantial among 1-year survivors. Although mean
incremental costs were highest for definite cases, probable and possible cases
accounted for>90% of all TBI events and 66% of total incremental costs.
Preventing probable and possible events might facilitate substantial reductions
in TBI-associated medical care costs.

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