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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.

Population Mean cost
Total group $258,890
C1-C4 AIS A, B or C $493,275
C5-C8 AIS A, B or C $342,171
T1-S5 AIS A, B or C $223,154
AIS D $143,095
Population Mean cost
Total group $80,219
C1-C4 AIS A, B or C $175,449
C5-C8 AIS A, B or C $104,045
T1-S5 AIS A, B or C $57,291
AIS D $39,092

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.

Population Mean cost
C1-C4 AIS A, B or C $3,161,079
C5-C8 AIS A, B or C $2,153,811
T1-S5 AIS A, B or C $1,292,696
AIS D $930,696
Population Mean cost
C1-C4 AIS A, B or C $1,777,250
C5-C8 AIS A, B or C $1,390,013
T1-S5 AIS A, B or C $904,193
AIS D $702,364

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.

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.

Year Mean cost in thousands (median costs in thousands)
C2-4 AIS A-C C5 AIS A-C C6 AIS A-C C7-8 AIS A-C Central cord AIS D
1 $853 ($850) $635 ($613) $670 ($659) $373 ($373) $237 ($211) $276 ($264)
1 $238 ($205) $232 ($218) $292 ($228) $160 ($155) $54 ($55) $42 ($31)
3 $169 ($169) $113 ($116) $213 ($225) $129 ($110) $47 ($47) $36 ($16)
4 $230 ($227) $145 ($113) $158 ($110) $128 ($123) $55 ($39) $7 ($7)
5 $164 ($142) $176 ($150) $205 ($134) $135 ($134) $48 ($38) $64 ($7)

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.

Mean cost (standard deviation)
Total cohort $21,070 ($7,005)
Individuals with infected PU $17,658 ($8,768)
Individuals with non-infected PU $13,038 ($7,393)

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).

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