Quantifying the funding gap for management of traumatic brain injury at a major trauma centre in South Africa

Abstract

Background: Trauma is an eminently preventable disease. However, prevention  programs divert resources away from other priorities. Costing trauma related diseases helps policy makers to make decisions on re-source allocation. We used data from a prospective digital trauma registry to cost Traumatic Brain Injury (TBI) at our institution over a two-year period and to estimate the funding gap that exists in the care of TBI.

Methods: All patients who were admitted to the Pietermaritzburg Metropolitan  Trauma Service (PMTS) with TBI were identified from the Hybrid Electronic Medical Registry (HMER). A micro-costing model was utilised to generate costs for TBI. Costs were generated for two scenarios in which all moderate and severe TBI were admitted to ICU. The actual cost was then sub-tracted from the scenario costs to establish the funding gap.

Results: During the period January 2012 to December 2014, a total of 3 301  patients were treated for TBI in PMB. The mean age was 30 years (SD 50). There  were 2 632 (80%) males and 564 (20%) females. The racial breakdown was  overwhelmingly African (96%), followed by Asian (2%), Caucasian (1%) and mixed  race (1%). There were 2 540 mild (GCS 13–15), 326 moderate (9–12), and 329 severe (GCS ≤8) TBI admissions during the period under review. A total of 139  patients died (4.2%). A total of 242 (7.3%) patients were admitted to ICU. Of these 137 (57%) had a GCS of 9 or less. A total of 2 383 CT scans were performed. The total cost of TBI over the two-year period was ZAR 62 million. If all 326 patients with moderate TBI had been admitted to ICU there would have been a further 281 ICU admissions. This was labelled Scenario 1. If all patients with severe as well as moderate TBI had been admitted there would have been a further 500 ICU  admissions. This was labelled Scenario 2. Based on Scenario 1 and Scenario 2 the total cost would have been ZAR 73 272 250 and ZAR 82 032 250 respectively. The funding gaps for Scenario 1 and Scenario 2 were ZAR 11 240 000 and ZAR 20 000 000 respectively.

Conclusion: There is a significant burden of TBI managed by the PMTS. The cost of managing TBI each year is in the order of sixty million ZAR. A significant funding gap exists in our environment. This data does not include any data on the broader social costs of TBI. Investing in programs to reduce and prevent TBI is justified by the potential for significant savings.