Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Although the majority of the global disease burden occurs in low- and middle-income countries, there is a paucity of data on economic costs attributable to TBI.
Methods: We used a prognostic model to estimate outcomes of treatment for severe TBI data from a patient cohort at the national referral hospital in Kampala, Uganda over 13 months. To evaluate long-term impact of treatment for severe TBI, averted cost/disability-adjusted life year (DALYs) were calculated and converted to dollars using human capital and value of a statistical life (VSL) approaches. We calculated unweighted averted DALYs (i.e. DALYs[0,0,0]); weighted averted DALYs with age weighting factor peaking at 25 years (ß=0.04) and 3% discount rate (i.e. DALYs[3,1,0.04]); and weighted averted DALYs with age weighting factor peaking at two-thirds of mean Ugandan life expectancy (ß=0.03) and 3% discount rate (i.e. DALYs[3,1,0.03]). This cohort was used as a representative sample to assess benefit for all of Uganda.
Results: From May 2008 to June 2009, 127 severe TBI cases were treated at New Mulago Hospital averting 1,448 DALYs [0,0,0], 1,075 DALYs [3,1,0.04], or 974 DALYs [3,1,0.03]. Using the human capital approach, the economic benefit ranged from approximately $1.3 to $1.7 million. The VSL approach estimated an economic benefit of $282,902 to over $11 million. The health benefit of severe TBI treatment for all Ugandans was estimated at between 11,000 and 17,000 averted DALYs per year with an annual potential economic benefit of $15 to $20 million using the human capital approach and $3.3 to $130 million using the VSL approach.
Conclusions: Severe TBI treatment in Uganda has potential to reduce a significant proportion of morbidity and mortality, and potentially produce a significant amount of economic gain.
Patient Care: This research will improve patient care by providing a context for understanding how basic neurosurgical interventions have the potential to provide tremendous economic and clinical benefit for patients in developing countries.
Learning Objectives: By the conclusion of this session participants should be able to:
1. Identify the role of neurosurgical intervention for severe traumatic brain injury in Kampala, Uganda
2. Describe the potential economic benefits of neurosurgical intervention for traumatic brain injury in Kampala, Uganda
3. Discuss how this data may be generalizable to other low- and middle- income countries and potentially affect policy