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Economic Evaluation

Canada

A total of 6 studies investigated SCI cost of illness from a Canadian health care system perspective (Dryden et al. 2005; Bradbury et al. 2008; Munce et al. 2013; Radhakrishna et al. 2014; White et al. 2017; Chan et al. 2018). Dryden and colleagues (2005) examined a cohort of individuals from Alberta. Costs were stratified by level of injury (tetraplegia versus thoracic versus lumbar) and whether it was complete or incomplete. Results were further stratified for first year after injury and years 2-6. Inpatient hospital, physician, home-care and long-term care costs were included in their analysis. Since this study had a non-SCI comparator both incidence and attributable costs were calculated. Administrative data was used to identify cohort and extract costing information; thus the study is limited by the quality of the administrative data. Results were calculated from 2009 costs and are shown in tables 8-10.

Mean cost
Population Total Hospital Physician
Tetra complete $163.517 $152,887 $10,630
Tetra incomplete $48,286 $45,233 $3,053
Thoracic complete $112,743 $105,845 $6,898
Thoracic incomplete $37,317 $34,603 $2,940
Lumbar/Cauda Equina $50,548 $46,703 $3,845
Unspecified $17,415 $15,040 $2,375
                                                   Mean Cost
Population Total Hospital Physician Home care Long-term care
Tetra complete $170,641 $5,654 $905 $565 $0
Tetra incomplete $51,679 $1,922 $565 $339 $565
Thoracic complete $118,284 $3,166 $678 $1,018 $678
Thoracic incomplete $39,579 $679 $565 $0 $792
Lumbar/Cauda Equina $53,375 $1,809 $792 $226 $0
Unspecified $25,104 $7,124 $565 $0 $0
Mean cost
Population Total Hospital Physician Home care Long-term care
Tetra complete $60,612 $17,867 $4,863 $37,204 $679
Tetra incomplete $17,867 $6,220 $2,488 $3,732 $5,428
Thoracic complete $27,931 $10,630 $2,488 $7,237 $7,577
Thoracic incomplete $18,093 $5,993 $3,279 $792 $792
Lumbar/Cauda Equina $7,690 $3,958 $2,375 $1,357 $0
Unspecified $14,927 $5,541 $1,696 $7,690 $0

Radhakrishna and colleagues also examined the health care costs for the first- and second-year post-SCI resulting from motor vehicle accidents in Quebec, Canada. The cohort was stratified by level and severity of injury. The total costs for the first year are presented in Table 11. Second year costs are presented in Table 12.

Mean cost (standard error)
Population Acute hospital care Total
C1-C7/complete injury $126,555 ($23,805) $153,045 ($24,290)
C8-T6/complete injury $61,459 ($8,218) $93,609 ($12,120)
T7-L1/complete injury $40,405 ($3,913) $68,860 ($8,186)
C1-C7/incomplete injury $42,648 ($3,643) $54,830 ($4,108)
C8-T6/incomplete injury $45,195 ($8,817) $55,995 ($12,568)
T7-L1/incomplete injury $36,702 ($2,690) $43,208 ($3,282)
L2-S5/incomplete injury $50,750 ($7,728) $66,872 ($10,462)
Population Mean total cost (standard error)
C1-C7/complete injury $79,171 ($12,321)
C8-T6/complete injury $49,230 ($9,487)
T7-L1/complete injury $32,391 ($6,878)
C1-C7/incomplete injury $15,990 ($3,009)
C8-T6/incomplete injury $9,368 ($4,493)
T7-L1/incomplete injury $6,575 ($1,754)
L2-S5/incomplete injury $13,568 ($3,894)

An Ontario SCI cohort was investigated by Munce and colleagues (2013) using administrative data. Prevalent cost per year for SCI was calculated for inpatient hospital, emergency department visits, physician, home care, long-term care and drugs. Results were presented for fiscal years 2003 to 2005 and were presented in 2005 dollars. The general SCI cohort was explored with no further SCI subgrouping. Regression analyses were conducted to look at factors that may influence increased costs (Table 13).

  Mean cost (standard deviation)
Total Index hospital Hospital re-

admission

Inpatient rehab Complex continuing care Emergency department Physician Home-care
$114,993 $34,016 ($43,899) $19,045 ($33,175) $116,138 ($76,202) $159,802 ($105,124) $433

($379)

$4,945 ($7,845) $2,915 ($7,845)

Bradbury and colleagues (2008) investigated the cost of rehabilitation in 2006 dollars for individuals with SCI from the perspective of the rehabilitation facility. The primary focus of this study was to investigate the clinical and economic impact of TBI in patients with SCI in a rehabilitation setting. Mean costs for an incidence population were presented and stratified for individuals with and without TBI. Costs per change in functional independence motor score were also computed. In total, 10 patients with TBI and SCI were compared with 10 patients without TBI (Table 14).

Mean hospital cost (standard deviation)
SCI with TBI $174,544 ($86,373)
SCI without TBI $134,555 ($93,251)

The estimated 5 year and lifetime cost of SCI from the perspective of the Ontario Ministry of Health and Long-term Care was calculated by Chan and colleagues (Chan et al. 2018). The primary data source for this study was health care administrative data. The estimated lifetime additional health care cost of SCI for the entire SCI cohort and stratified by location of injury is presented in Table 15. The calculated five-year additional cost of SCI is $150,810 ($146,973-$154,131 95% confidence interval).

Location of injury Mean cost (95% confidence interval)
Total cohort $284,163 ($275,877-$291,603)
Cervical $278,668 ($270,805-$285,939)
Thoracic $308,513 ($300,650-$315,784)
Lumbar $189,132 ($183,298-$194,712)

The additional acute hospital cost of hospital-acquired UTI and PU was examined in a cohort of individuals enrolled in the Rick Hansen SCI registry (White et al. 2017). Individuals with SCI identified by hospital-acquired UTI or PU were matched with those without the complication. The difference in acute hospital costs was considered the additional cost of the complication. Mean hospital costs are presented in Table 16.

Mean hospital cost (standard deviation)
Hospital-acquired UTI $6,832 ($5,497)
Hospital-acquired PU $16,452 ($24,185)
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