Traumatic brain injury (TBI) is a critical cause of death and disability worldwide. Improvements in intensive care management and medical technology have made it possible for many severe TBI patients to survive. Patients with more severe injuries require longer-term treatment and are more likely to have persistent functional disabilities, incurring substantial medical and social costs. The World Health Organization predicted that the disease burden due to TBI will be higher in 2030. A systematic analysis of the global, regional, and national burden of TBI was recently published as part of the Global Burden of Disease Study 2016 [1]. However, this analysis mainly focused on the occurrence of TBI, and data on the real socioeconomic burden of TBI are lacking. The Global Commission announced the need for intensive long-term health economic research on the direct and indirect costs in TBI in order to face the socioeconomic burden of TBI and reduce its impact on individuals and societies [2].
The Korea Disease Control and Prevention Agency (KDCA) has conducted the National Injury Hospital Discharge Survey since 2005. In 2017, a total of 1,126,331 patients were discharged from hospitals due to injury, and 131,996 (11.7%) of them were patients with TBI. These data are publicly available and can be easily obtained from the KDCA, but are not fully representative of the scope of TBI because the KDCA dataset only includes hospitalized patients in sample hospitals and it does not contain information related to cost.
In this issue, 2 excellent original articles, presenting real-world research conducted in Korea, were published on the epidemiology, medical care and rehabilitation utilization, and socioeconomic burden of TBI.
Kim et al. [3] investigated approximately 480,000 new TBI cases annually from National Health Insurance Service and Health Insurance Review and Assessment data. They reported increases in total medical costs, oriental medical costs, and costs of inpatient services per capita per year. The average length of stay and number of clinic visits showed differences according to insurance type, and I carefully agree with the author’s interpretation regarding excessive or unnecessary medical services. However, a more accurate analysis would require studying medical utilization according to disease severity. This study demonstrated that more prescriptions for specialized rehabilitation therapy were filed for patients with automobile insurance than for those with national health insurance. Further research should also analyze relationships between rehabilitation utilization and patient characteristics such as age, sex, or disease severity.
Lee et al. [4] reported the socioeconomic burden of acquired brain injury (ABI) in Korea. The socioeconomic burden of ABI was approximately 5 trillion KRW, corresponding to 0.3% of Korea’s GDP annually, and it is increasing every year. The authors reported very well-organized direct medical, non-medical costs, and indirect costs for ABI according to disease, age, sex, and insurance type. TBI accounted for 18% of the entire socioeconomic burden of ABI. The socioeconomic burden of TBI was higher in male and elderly patients. A particularly noteworthy result of this study is that TBI has higher medical costs in the acute phase than in the convalescent phase. I agree with the author’s interpretation that inadequate rehabilitation services are provided during the convalescent phase in TBI. Therefore, experts in neurorehabilitation should take particular interest in the convalescent phase of TBI as it relates to interventions.
The above 2 studies reported excellent results from well-chosen subjects. However, these two studies were conducted by the same team of researchers. More studies are needed with diverse perspectives of more researchers in many countries.
In Korea, like in other developed countries, it is necessary to manage patient data efficiently with a registration system for TBI patients. Through such a system, we should select groups at high risk for TBI and take steps to prevent TBI occurrence. Not only epidemiological and functional data of TBI patients, but also socioeconomic data should be collected, and this information should be reflected in national medical welfare policies. Furthermore, a clinical guideline on TBI suitable for domestic circumstances should be provided, and rehabilitation should be included to facilitate functional improvement and social participation.
Footnotes
Conflict of Interest: The author has no potential conflicts of interest to disclose.
References
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