Summary
According to one study, intrathecal baclofen as first-line therapy for disabling spasticity for severely impaired individuals had lower treatment costs and better outcomes (improved patient and caregiver satisfaction according to goal attainment scaling and at least 1-point reduction in Ashworth score) over a 2-year period when compared to the current treatment pattern of care in France at the time of model construction.
Considering the long-term outcomes associated with intermittent catheterization, hydrophilic catheters may be cost-effective when compared to uncoated catheters.
Trans-anal irrigation was observed to be less costly than conservative bowel management for a two-day period and less costly than ineffective standard bowel management over a lifetime time horizon. Trans-anal irrigation had better clinical outcomes (St Mark’s fecal incontinence score, Cleveland Clinic constipation score and neurogenic bowel dysfunction score) over 10 weeks when compared to conservative bowel management and resulted in higher QALYs when compared to ineffective standard bowel management.
In a single study, sacral anterior root stimulation appears to be cost-effective for neurogenic bladder.
Based on one study, the implementation of duplex ultrasound for deep venous thrombosis surveillance would result in a cost per life year gained of between $1,193 and $9,050 depending on age and type of injury.
In one study, sildenafil had lower cost and better outcomes than intracavernous injections, suppositories and surgery. Cost per QALY was $9,656/QALY for Triple Mix intercavernous injections and $13,399/QALY for vacuum erection device.
For a single study, over a one-year timeframe, electrical stimulation in addition to standard wound care had lower costs and greater number of wounds healed.
In one study, the addition of telephone support to standard pressure injury management appears to be cost effective.
In a single study, negative pressure wound therapy with weekly dressing changes was less costly than standard care (with one to two changes a day) at nine weeks.
In one study, fibrin sealant for the surgical treatment of pressure injuries resulted in less cumulative costs at six months post-discharge compared to conventional surgical debridement for individuals with SCI.
Based on a single study, the decrease in respiratory tract infection and amount of caregiver support over a three-year period resulted in lower overall cost with a Cough Stimulator neuroprosthesis compared to standard respiratory management for restoration of an effective cough.
In a single study, surgical and rehabilitative management of older individuals with traumatic cervical SCI were costlier in the first six months after injury compared to younger individuals.
In one study, early decompression for individuals with traumatic cervical SCI resulted in lower costs in the first six months after injury both motor complete and motor incomplete individuals.
In a single study, additional services for supported employment for US veterans did not result in a statistically significant reduction in cost or gain in QALYs.
The mean hospital cost for traumatic SCI in Australia is approximately $52,000 for initial hospitalization and $10,700 for subsequent hospitalizations; for non-traumatic SCI it is approximately $17,900 for initial hospitalization and $17,350 for subsequent hospitalizations. The mean cost of a secondary condition results in a hospital visit costing $10,900 for any urological condition to $22,100 for pressure injuries. The mean cost per hospital visit can range between $7,700 for an individual with incomplete thoracic SCI and $13,100 for a complete thoracic SCI. The mean cost per emergency department visit is between $404 for lumbar SCI and $584 for complete thoracic SCI.
In Belgium, mean cost for inpatient and outpatient rehabilitation is approximately $46,000 and $7,900 for paraplegia and approximately $71,000 and $10,700 for tetraplegia, respectively.
In Canada, mean costs range between $17,500 and $164,000 for initial hospitalization, $25,000 to $170,500 in the first-year and $7,500 to $60,500 for following years depending on type of injury. Second-year mean costs were between $6,600 and $79,200 depending on level and severity of SCI. Total mean cost of inpatient rehabilitation is approximately $134,500 for SCI and is increased to approximately $174,500 if the patient also has a TBI. Total mean annual cost per individual with SCI in Ontario is approximately $115,000. Individuals with SCI who develop a UTI during an acute hospital stay have $6,800 higher hospital cost. Hospital-acquired PU for individuals with SCI is associated with an increase of $16,500 in acute hospital cost.
The direct out-of-pocket cost for conservative SCI management in Nigeria is approximately $280 and $1,900 for lost income and vehicle repair/replacement.
Total mean lifetime cost for an individual with a SCI that is a result of a motor crash is approximately $279,500 and $296,500 from other causes in Spain.
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.
