Economic Evaluation

United States

There were a total of 6 cost-of-illness studies from the US that examined an SCI cohort.

In a review of the 2009 Health Care Utilization Project Nationwide Inpatient Sample database, hospitalizations where the primary diagnosis was SCI had a mean charge of $165,958 ($8,662 standard deviation) (Mahabaleshwarkar et al. 2014). This was higher than the mean charge of $40,813 ($1,223 standard deviation) for a matched non-SCI group (Mahabaleshwarkar et al. 2014).

DeVivo and Farris (2011) calculated the incident cost of SCI in a US population. Costs were presented in 2009 dollars. Results were separated to first year costs and annual costs for subsequent years. Results were presented for the entire cohort as well as stratified by level of injury and severity (C1-C4 and AIS A, B or C, C5-C8 AIS A, B or C and AIS D). Total mean costs were presented. This study provides updated data from the National SCI Statistical Center including new variables that were not available in past reports.

Table 19. First year SCI costs as reported by DeVivo and Farris (2011)

Table 20. SCI costs after the first year as reported by DeVivo and Farris (2011)

In another US study, Cao et al. (2011) calculated the mean cost of the same SCI cohort as DeVivo and Farris (2011) but modelled the lifetime costs for SCI. Results were divided in a similar manner to DeVivo and Farris (2011) and were based on the 2009 dollar.

Table 21. Estimated lifetime SCI costs for a hypothetical 25 year-old, using 4% discount rate as reported by Cao et al. (2011)

Table 22. Estimated lifetime SCI costs for a hypothetical 50 year old, using 4% discount rate as reported by Cao et al. (2011)

Lifetime all-cause hospitalization cost for individuals with thoracic SCI was estimated by Dukes and colleagues using data from the National Spinal Cord Injury Statistical Center. Estimates were based on an individual injured at the age of 35 years. Results were stratified by AIS grade. Results are presented in Table 23.

Table 23. Estimated life-time all-cause hospital costs for a hypothetical individual with SCI injured at 35-year old stratified by severity (Dukes et al. 2018)

For individuals with a work-related SCI and eligible for workers’ compensation, health care claims made to a compensation insurer were analyzed. Total costs for claims per person for the first five years is presented in Table 24.

Table 24. Estimated total costs of health care claims submitted to insurer for individuals with SCI on workers’ compensation

The cost of acute hospitalization for PU along with readmissions up to one year after the initial hospitalization was calculated for individuals with SCI resulting from gun-shot by Chopra and colleagues (Chopra et al. 2016). The mean total cost of hospitalizations (initial admission with readmissions) for the total cohort and stratified by infected and uninfected PU is presented in Table 25.

Table 25. Mean cost of hospitalizations (up to one year from initial hospitalization) for individuals with PU and gun-shot related SCI reported in Chopra et al. (2016)

A separate study examining the additional health care cost of neuropathic pain (NeP) for individuals with SCI in the first year post-injury (Margolis et al. 2014b). In this study, the total first year cost for individuals with NeP and SCI was compared to a matched cohort without NeP. The presence of NeP resulted in an increase in mean cost of $18,920 ($10,624-$27,836 95% confidence interval) in the first year. The cost components in this analysis included acute hospital admissions, emergency department visits, physician visits, procedures and outpatient drug claims. In a similar analysis of a larger data set with the same cost components with the addition of physical therapy, the additional health care cost for individuals with NeP was $24,558 ($20,707-$28,504 95% confidence interval) in the first year (Margolis et al. 2014a).

In the US, mean costs are approximately $260,000 for first year, and $80,000 for following years. Mean costs range from approximately $143,000 to $493,000 in first year and $39,000 to $175,500 in following years depending on location and severity of injury. Estimated lifetime costs for an individual injured at 25 years old is approximately between $931,000 and $3.2 million and for an individual injured at 50 years old, approximately between $702,000 to $1.8 million depending on location and severity of injury. The estimated lifetime hospital costs for an individual injured at 35 years old is between $72,000 and $339,000 depending on level of SCI severity. First year cost for health care claims through workers’ compensation for individuals with work-related SCI ranged from $276,000 to $853,000 depending on level of injury. By the fifth year the cost was between $64,000 and $205,000.

The cost of hospitalization and readmissions for individuals with PU and gun-shot related SCI is approximately $21,100. The presence of neuropathic pain increased first-year health care costs by $18,900 to $24,600.

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