• Rahul Raj, Stepani Bendel, Matti Reinikainen, Sanna Hoppu, Teemu Luoto, Tero Ala-Kokko, Sami Tetri, Ruut Laitio, Timo Koivisto, Jaakko Rinne, Riku Kivisaari, Jari Siironen, Alisa Higgins, and Markus B Skrifvars.
• Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
• Crit. Care Med. 2018 Apr 1; 46 (4): e302e309e302-e309.

ObjectiveTo assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland.DesignRetrospective observational cohort study.SettingMulticenter study including four tertiary ICUs.PatientsThree thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003-2013.InterventionNone.Measurements And Main ResultsTotal 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3-8, 9-12, and 13-15) and age (18-40, 41-64, and ≥ 65 yr) subgroups. Overall 1-year survival was 76% (n = 2,304), and of 1-year survivors, 37% (n = 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144-$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13-15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05).ConclusionDuring the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.

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