Department of Neurosurgery, Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurosurgery, Neurosurgical Center Holland, Haaglanden Medical Center, The Hague, The Netherlands.
PLoS One. 2019 May 9;14(5):e0216743. doi: 10.1371/journal.pone.0216743. eCollection 2019.
The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe TBI (s-TBI). To improve future treatment decision-making, resource allocation and research initiatives, this study reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology.
A systematic search was performed using the following databases: PubMed, MEDLINE, Embase, Web of Science, Cochrane library, CENTRAL, Emcare, PsychINFO, Academic Search Premier and Google Scholar. Articles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement.
Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% - 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported.
Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality.
创伤性脑损伤（TBI）患者的院内治疗被认为费用高昂，尤其是严重 TBI（s-TBI）患者。为了改进未来的治疗决策、资源分配和研究计划，本研究回顾了 s-TBI 患者的院内费用和研究方法学的质量。
使用以下数据库进行了系统检索：PubMed、MEDLINE、Embase、Web of Science、Cochrane 图书馆、CENTRAL、Emcare、PsychINFO、Academic Search Premier 和 Google Scholar。纳入了报告 s-TBI 患者院内急性治疗费用的发表于 2018 年 8 月之前的文章。使用基于 CHEERS 声明的 19 项清单评估质量。
2372 篇文章中有 25 篇被纳入。每位患者的院内费用普遍较高，范围从 2130 美元到 401808 美元不等。研究结果的差异主要是由于方法学的异质性以及患者和治疗特征的变化。质量评估显示研究质量存在差异，总得分平均为 71%（48%至 96%）。特别是关于成本数据的项目得分较低（49%），因为成本数据来源、成本计算方法和结果报告经常未提及或报告不充分。
s-TBI 患者的医疗保健消费和院内费用很高，且各研究之间差异很大。费用主要由住院时间和手术干预驱动，并随 TBI 严重程度的增加而增加。然而，由于纳入研究的变异性和质量不足，很难对 s-TBI 患者的实际院内费用得出明确结论。未来的经济评估应侧重于治疗策略的长期成本效益，并使用指南建议和通用数据元素来提高研究质量。
