Every year, more than 600,000 children visit U.S. emergency rooms for traumatic brain injuries (TBI). Many more children are treated in office settings for less severe TBI, such as concussions. The immediate health care costs to treat pediatric TBI can be substantial, but, until now, there were no data that accounted for longer-term follow-up treatment expenses across the spectrum of TBI severity, especially for care received outside of the hospital.
A new study from researchers at Washington State University and the University of Washington’s Harborview Injury Prevention and Research Center finds that children with concussions and other mild TBIs, despite being up to eleven times less expensive to treat, accounted for nearly 81% of the $1.59 billion in healthcare costs one year after pediatric TBIs. These cases accounted for 96.6% of the roughly 600,000 patients in the study.
This study is important, said lead author Janessa Graves, PhD MPH, because it provides evidence that mild TBI prevention strategies could lead to significant cost savings.
“Mild TBI cannot be thought of as a low-cost or short-term problem. The study demonstrates that concussion costs account for a disproportionate cost burden at the macro level.”
The study, published Aug. 13 in the American Journal of Public Health, found that individual healthcare costs in the three months after injury are significantly higher for moderate and severe TBI than mild TBI. Compared with mild TBI cases, adjusted total health care costs for moderate TBI cases were five times higher in the first three months after injury and two times higher in the four to six months after injury.
While previous studies describe the costs associated with pediatric TBI, they focused only on limited geographic areas or immediate costs following injuries. By and large, most research on pediatric TBI costs have focused largely on more severe cases of TBI.
“No study has looked at a sample this large and over the long term,” said co-author and HIPRC Director Monica Vavilala, MD. “We aimed to capture data from the largest possible sample and over the time period where the majority of associated costs occur.”
The study used a commercial insurance claims database, to which nearly half of US health insurers contribute data, to provide a comprehensive estimate of total health care costs. For all cases of pediatric TBI, the majority of costs occurred within three months of injury. During this time, the median individual cost was $1,004 for mild TBI; $4,347 for moderate TBI; and $7,265 for severe TBI cases.
All of the authors are affiliated with the Harborview Injury and Research Center (HIPRC), Seattle, WA. Janessa M. Graves is also with the College of Nursing, Washington State University Spokane. Frederick P. Rivara is also with the Departments of Pediatrics and Epidemiology, University of Washington. Monica S. Vavilala is also with the Departments of Anesthesiology & Pain Medicine and Pediatrics, University of Washington.