Raj, R., Bendel, S., Reinikainen, M., Hoppu, S., Luoto, T., Ala-Kokko, T., Tetri, S., Laitio, R., Koivisto, T., Rinne, J., Kivisaari, R., Siironen, J., Higgins, A., Skrifvars, M. (2018) Temporal Trends in Healthcare Costs and Outcome Following ICU Admission After Traumatic Brain Injury. Critical Care Medicine, 46 (4), e302-e309. doi:10.1097/CCM.0000000000002959
Temporal trends in healthcare costs and outcome following ICU admission after traumatic brain injury
|Author:||Raj, Rahul1; Bendel, Stepani2; Reinikainen, Matti3;|
1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
3Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland
4Department of Intensive Care, Tampere University Hospital & University of Tampere, Tampere, Finland
5Department of Neurosurgery, Tampere University Hospital & University of Tampere, Tampere, Finland
6Department of Intensive Care, Oulu University Hospital & University of Oulu, Oulu, Finland
7Department of Neurosurgery, Oulu University Hospital & University of Oulu, Oulu, Finland
8Department of Intensive Care, Turku University Hospital & University of Turku, Turku, Finland
9Department of Neurosurgery, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
10Department of Neurosurgery, Turku University Hospital & University of Turku, Turku, Finland
11Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
12Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
13Department of Intensive Care, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
|Online Access:||PDF Full Text (PDF, 0.2 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2019062521813
|Publish Date:|| 2019-06-25
Objective: To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland.
Design: Retrospective observational cohort study.
Setting: Multicenter study including four tertiary ICUs.
Patients: Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013.
Measurements and Main Results: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥65 yr) subgroups. Overall 1-year survival was 76% (n= 2,304), and of 1-year survivors, 37% (n= 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05).
Conclusion: During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.
Critical care medicine
|Pages:||E302 - E309|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3126 Surgery, anesthesiology, intensive care, radiology
Supported by grants from Helsinki University (three-year project grant: H3702 73702705) and Helsinki University Hospital (state funding: VTR-TYH2014221). Dr. Raj received personal research grants from Svenska Kulturfonden (Grant 17/2921), Medicinska Understödsföreningen Liv and Hälsa, Finska Läkaresällskapet, Maud Kuistilan Säätiö, Eemil Aaltosen Säätiö, Ella and Georg Ehrnroothin Säätiö, Suomalais-Norjalainen Lääketieteen Säätiö, Suomen Lääketieteen Säätiö, and Maire Taposen Säätiö. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the article. Dr. Laitio received funding from Consultancy for Valvira, Finland (National Supervisory Authority for Welfare and Health). Dr. Skrifvars’ institution received funding from Finska Läkaresällskapet, and he received funding from Svenska Kulturfonden. The remaining authors have disclosed that they do not have any potential conflicts of interest.
© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.