Estimating US Health Care Spending on Traumatic Brain Injury

Abstract

Importance: Traumatic brain injury (TBI) is a major cause of morbidity and mortality and imposes substantial demands on the US health care system. However, national estimates of TBI-related health care spending are limited. Objective: To comprehensively estimate US health care spending on TBI by type of injury, payer, age group, sex, care setting, and geography from 2010 to 2019. Design, Setting, and Participants: Descriptive analysis of US health care spending from 2010 to 2019. Claim- and encounter-level data from the Centers for Medicare & Medicaid Services (CMS), Kythera, MarketScan, and the Healthcare Cost and Utilization Project (HCUP) were used to estimate TBI-related spending fractions and utilization proportions, which were applied to scaled spending and utilization estimates from the Disease Expenditure Project. TBI incidence estimates were obtained from the Global Burden of Disease Study. Exposures: Injury-related health care encounters with a diagnosis of traumatic brain injury or skull fracture. Main Outcomes and Measures: Total and per capita TBI-related health care spending and utilization, stratified by type of injury, payer, care setting, age group, sex, and state; age-standardized estimates; and drivers of changes in spending over time. Results: Total TBI-related health care spending in 2019 was estimated at $4.9 billion USD (95% CI: $4.7 billion – $5.1 billion USD). Spending was higher among males than females across nearly all age groups and was concentrated among young men, despite TBI incidence peaking at older ages. Spending patterns varied by geography, type of injury, payer, and care setting: among younger adults, road injuries and private insurance accounted for most spending, whereas falls and Medicare made up the majority of spending at older ages. Inpatient care accounted for the largest fraction when disaggregating by care setting. From 2010 to 2019, TBI-related annual spending decreased by 14.5% (11.3%–18.8%), driven by reductions in inpatient and road injury-related spending, while spending increased for fall-related TBIs and non-inpatient care. Conclusions and Relevance: Despite TBI incidence peaking at older ages due to falls, most TBI-related health care spending in the US in 2019 was concentrated among young men with road injury-related TBIs. These funds were predominantly spent in inpatient hospital settings and primarily financed by private insurance.