Traumatic Brain Injury in the Netherlands: Incidence, Costs and Disability-Adjusted Life Years
Costs and Disability-
Adjusted Life Years. PLoS ONE 9(10): e110905. doi:10.1371/journal.pone.0110905
Traumatic Brain Injury in the Netherlands: Incidence, Costs and Disability-Adjusted Life Years
Annemieke C. Scholten 0
Juanita A. Haagsma 0
Martien J. M. Panneman 0
Ed F. van Beeck 0
Suzanne Polinder 0
Subhra Mohapatra, University of South Florida, United States of America
0 1 Department of Public Health, Erasmus University Medical Center , Rotterdam , The Netherlands , 2 Research Department, Consumer and Safety Institute , Amsterdam , The Netherlands
Objective: Traumatic brain injury (TBI) is a major cause of death and disability, leading to great personal suffering and huge costs to society. Integrated knowledge on epidemiology, economic consequences and disease burden of TBI is scarce but essential for optimizing healthcare policy and preventing TBI. This study aimed to estimate incidence, cost-of-illness and disability-adjusted life years (DALYs) of TBI in the Netherlands. Methods: This study included data on all TBI patients who were treated at an Emergency Department (ED - National Injury Surveillance System), hospitalized (National Medical Registration), or died due to their injuries in the Netherlands between 2010-2012. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model. Disease burden was assessed by calculating years of life lost (YLL) owing to premature death, years lived with disability (YLD) and DALYs. Incidence, costs and disease burden were stratified by age and gender. Results: TBI incidence was 213.6 per 100,000 person years. Total costs were J314.6 (USD $433.8) million per year and disease burden resulted in 171,200 DALYs (on average 7.1 DALYs per case). Men had highest mean costs per case (J19,540 versus J14,940), driven by indirect costs. 0-24-year-olds had high incidence and disease burden but low economic costs, whereas 25-64-year-olds had relatively low incidence but high economic costs. Patients aged 65+ had highest incidence, leading to considerable direct healthcare costs. 0-24-year-olds, men aged 25-64 years, traffic injury victims (especially bicyclists) and home and leisure injury victims (especially 0-5-year-old and elderly fallers) are identified as risk groups in TBI. Conclusions: The economic and health consequences of TBI are substantial. The integrated approach of assessing incidence, costs and disease burden enables detection of important risk groups in TBI, development of prevention programs that target these risk groups and assessment of the benefits of these programs.
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Funding: These authors have no support or funding to report.
Competing Interests: The authors have declared that no competing interests exist.
Traumatic brain injury (TBI) defined as an alteration in brain
function, or other evidence of brain pathology, caused by an
external cause [1] is a leading cause of morbidity, disability, and
mortality worldwide. In Europe, the annual incidence rate of
hospitalized and fatal TBI is about 235 per 100,000 person years
[2]. TBI survivors almost all experience some level of impairment
or disability [2], which drastically reduces their health-related
quality of life (HRQL) [3,4].
In addition to the often long-term impact of TBI on a persons
life, the economic consequences of TBI for both individuals and
society are substantial [5,6]. TBI patients require specialized
prehospital care, transport, in-hospital (emergency) care, and often
long-term rehabilitation. Survivors of more severe TBI are often
unable to return to full employment [7,8]. TBI therefore leads to
significant direct healthcare costs in terms of pre-hospital care,
emergency care, hospitalization, long-term outpatient care and
rehabilitation, and indirect costs due to loss of productivity. The
total direct and indirect costs of TBI occurring in Europe were
estimated to J33 billion (approximately USD $45.4 billion) [9].
Most efforts on assessing the impact of TBI have been limited to
either its epidemiology [2,10,11], costs [5,6,9,1218] or disease
burden [17,19,20]. Integrated knowledge on epidemiology,
economic consequences and disease burden of TBI is scarce but
essential for optimizing healthcare policy, allocating scarce
resources, preventing TBI, and developing effective healthcare
and rehabilitation services. Up till now, an insight of the total
population impact of TBI is lacking. The purpose of this study was
to estimate the incidence, cost-of-illness and disability-adjusted life
years (DALYs) of TBI in the Dutch population, and to detect
important risk groups in TBI.
Data sources
This surveillance-based study included data on all patients with
TBI treated at an ED and/or admitted to hospital in the
Netherlands in the period 20102012. TBI cases were extracted
from the Dutch Injury Surveillance System (LIS) [21] and the
National Hospital Discharge Registry (LMR) [22], to include data
of TBI patients treated at the ED and hospi (...truncated)