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| BRIEF REPORT |
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| Year : 2006 | Volume
: 54
| Issue : 1 | Page : 78-80 |
Economics of head injuries
Manmohan Singh, Sandeep Vaishya, Shakti Gupta, VS Mehta
Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi - 110 029, India
Correspondence Address:
V S Mehta
Chief of Neurosciences Center, Neurosciences center, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.24714
Summary: Head injuries account for significant proportion of neurosurgical admissions and bed occupancy. Patients with head injuries also consume significant proportions of neurosurgical resources. A prospective 6-month study has been carried out to evaluate the expenditure incurred on head injury patients in a modern neurosurgical center equipped with state of the art infrastructure. Costing areas included wages / salaries of health care personnel, cost of medicines / surgical items / crystalloids, general store items, stationary, all investigation charges, equipment cost, overhead building cost, maintenance cost, electricity and water charges and cost of medical gases, air conditioning and operation theatre expenses. Expenditure in each area was calculated and apportioned to each bed. The statistical analysis was done using X2 test. The cost of stay in ward was found to be Rs. 1062 / bed / day and in neurosurgical ICU Rs. 3082 / bed / day. The operation theatre cost for each surgery was Rs. 11948. The cost of hospital stay per day for minor, moderate and severe head injury group was found to be Rs. 1921, Rs. 2569 and Rs. 2713 respectively. The patients who developed complications, the cost of stay per day in the hospital were Rs. 2867. In the operative group, the cost of hospital stay per day was Rs. 3804. The total expenditure in minor head injury was Rs. 7800 per patient, in moderate head injury was Rs. 22172 per patient, whereas in severe head injury, it was found to be Rs. 32852 per patient. Patients who underwent surgery, the total cost incurred was Rs. 33100 per operated patient.
Keywords: Head injury, neurotrauma, cost analysis, economics.
How to cite this article:
Singh M, Vaishya S, Gupta S, Mehta V S. Economics of head injuries. Neurol India 2006;54:78-80 |
| Introduction | |  |
Patients suffering from head injuries account for significant proportion of neurosurgical admissions. Patients with severe head injuries constitute a continuing demand on surgical resources.[1] It is necessary to develop methods for calculating the hospital economics and applying them for medical benefits and quality of life.[2] This was a prospective study carried out to evaluate the expenditure incurred in mild, moderate and severe head injury patients.
| Materials and Methods | | |
A pre-tested proforma was filled up of the requirement of each patient who were followed up in ICU and wards from admission till discharge/death. Cost inputs like medicines and disposables along with information regarding laboratory, radiological and other investigations, I/V fluids, blood transfusion etc. were entered in the proforma. Total cost incurred in the management of neurotrauma patients was calculated by doing costing under various heads.
| Results | | |
During the study period, 330 patients [263 (79.7%) male, mean age 25.87 years (range 4 months to 78 years)] with all grades of head injuries were admitted. Of these minor head injury group comprised 167(50.6%) cases, moderate head injury group comprised 65(19.7%) cases and severe head injury group comprised 98(29.7%) cases. One hundred and four patients underwent surgical interventions. The mean hospital stay of these patients was 5.8 days with a range of 1-79 days. Mortality among these neurotrauma patients was 16.9% (56/330).
Cost of manpower [Table - 1]: As the nursing and class C and D employees are involved in only patient care, so for final calculation their whole salary was apportioned towards patient care. Whereas faculty members and residents besides providing patient care are also involved in the teaching and research work. Therefore the salary of faculty and residents was apportioned as per assumption that faculty and senior residents spend 67% and junior residents spend 50% of their time towards patient care (Tata consultancy services) 5.
Based on the capital and other cost [Table - 2] the total cost of staying in ward came out to be Rs. 1062/bed/day. The total cost of stay in ICU turned out to be Rs. 3082/bed/day. The total cost in per operation came out to be Rs. 11948/operated patient.
The comparative analysis of various groups has been tabulated in [Table - 3]. The statistical analysis of these various groups was done by X 2sub test. The ICU stays and ward stay of severe and moderate head injury groups was significantly more as compared to minor head injury group ( P <.0001). Patients who developed complications during hospitalization, the hospital stay and overall expenditure per patient were significantly high ( P <.001) as compared to minor and moderate head injury group but not significant as compared to severe head injury and operative group. Expenditure incurred in operative group, who developed complications, was highest (Rs. 47552/patient), which is also statistically significant.
| Discussion | | |
Severe head injuries consume a substantial part of neurosurgical intensive care. Severe head injuries accounted for only 6.3% of total cases (Olmsted County hospital, Minnesota)[1] though consumed 36% of direct cost. The cost of inpatient hospital care for treating head injury was examined in 125 patients over the age of 50 years in a study done by Saywell.[3] Regression analysis indicated that injury severity, as measured by admitting G C S, was a good predictor for hospital costs. The regression relationship indicated that least injured and severely injured cost less than moderately injured patients. In the present study, it was observed that in patients with severe head injury group, the expenditure was high. Patients, who developed complications during admission, had highest expenditure per patient. New Zealand hospitals spend each year approximately $10.9 million on head injury patients in ICU's and $19 million on overall hospital stay (including ICU stay).[4]
Treatment in India is still considered a social obligation where cost considerations are irrelevant. Most of the hospitals have their own rate structure, which was initially based on what the neighboring hospitals were then charging their patients. These rates were revised from time to time. As the cost of running hospitals is increasing day by day, it is putting up a lot of pressure on the management to revise the rates upwards. The funds provided by Govt. local bodies and charitable organizations are also drying up. Thus the hospitals are forced to make the patients pay partly or wholly for the services availed by them. Unfortunately no regular cost accounting has been introduced in any of the hospitals of this country. Accounts are being maintained only to depict the receipts and expenditure of an accounting period, based on the conventional procedure. There is no uniform procedure for maintenance of accounts for these recurring items of expenditure in different hospitals in the country.
According to the Mudaliar Committee Report (1962),[6] the average cost per inpatient bed per day was Rs. 8/- in hospitals in Delhi. A similar picture was also projected by McGibony[7] in his report wherein he has tried to include the personnel cost in hospitals. The parameters utilized in both of these reports are undefined and hypothetical and hence the figures given therein are not strictly comparable besides being of doubtful accuracy if considered on the basis of cost accountancy.
The present study, which has been conducted to find the costing of head injury patients, is one of few of its kind in medical literature. Other studies have been directed towards costing of motor bike helmet injuries,[8] cost of head injuries in alcoholic patients,[9] costing of spinal injuries especially directed towards their rehabilitation,[10] costing of routine evaluation of DVT in head injury patients.[11]
Our neurosciences center accounts for 18.2% of total admissions. The severe head injury group comprised 30% of the patient input. The cost of ICU and ward per day was Rs. 3082 and Rs. 1062 per day respectively. The cost of each surgery was found to be Rs 11948. The maximum budgetary allocations were consumed by severe head injury group (Rs. 32852/patient). The patients who developed complications following trauma, the expenditure was highest (Rs. 37271/patient). The ICU stay of severe head injury group was significantly ( P <. 0001) high (374 patient days) as compared to minor head injury group (89 patient days). Similarly ward stay among the severe head injury group was highest (657 patient days).
Head injuries constitute a significant burden on health care resources. It is estimated that nearly 1.6 million people in India sustain head injuries annually.[12] The majority of these patients are young and in their productive life. This causes national loss, not only financially but also socially. By analyzing the workload and tremendous expenditure incurred on head injury patients, we can recommend the appropriate budgetary allocations.
| References | | |
| 1. | Grabow JD, Offords KP, Reider ME. Cost of head trauma in Olmsted county, Minnesota, 1970-74. Am J Public Health 1984;74:710-2.  |
| 2. | Mendelow AD, Campbell DA, Nordstorm CH, Marseter K. Severe traumatic brain lesions in Sweden. Brain Injury 1989;3:283-93. |
| 3. | Saywell RM Jr, Woods JR, Rappaport SA, Allen TL. The value of age and severity as prediction of costs in geriatric head trauma patients. J Am Geriatr Soc 1989;37:625-30. [PUBMED] |
| 4. | Havill JH, Sleigh JW, Kersel DA, Marsh NV. Profile and cost of head injury patients admitted to the Waikato Hospital intensive care unit. N Z Med J 1998;111:161-3. [PUBMED] |
| 5. | Tata consultancy services, c0 osts a0 ccounting System. All India Institute Of Medical Sciences: New Delhi; 1987. |
| 6. | Mudaliar committee, for evaluation of expenditure in Delhi Hospitals 1962. |
| 7. | McGibony JR, Principles of hospital administration. 2nd ed. JP Putanam and Sons: New York; 1967. |
| 8. | Muller AV, Evaluation of costs and benefits of motorcycle helmet laws. Am J Pub Health 1980;70:586-92. |
| 9. | Markert AV, Gryszkiewicz M, Korzycki J, Jakubowski JK, Orlicz B. Head injuries and alcohol- social and economic costs. Polski Tygodnik lekarski 1993;48:389-90. |
| 10. | Berkowitz AV. Assessing the socioeconomic impact of improved treatment of head and spinal cord injuries. J Emg Med 1993;11:63-7. |
| 11. | Methaler JM, DeVivo MJ, Hayne JB. Cost effectiveness of routine screening for proximal deep vein thrombosis in acquired brain injury patients admitted to rehabilitation. Arch Phys Med Rehab 1996;77:1-5. |
| 12. | Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002;24:24-8. [PUBMED] [FULLTEXT] |
Tables
[Table - 1], [Table - 2], [Table - 3]
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