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Chan BCF, Cadarette SM, Wodchis WP, Krahn MD, Mittmann N. The lifetime cost of spinal cord injury in Ontario, Canada: A population-based study from the perspective of the public health care payer. J Spinal Cord Med 2019; 42:184-193. [PMID: 29923798 PMCID: PMC6419658 DOI: 10.1080/10790268.2018.1486622] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To determine the publicly funded health care system lifetime cost-of-illness of spinal cord injury (SCI) from the perspective of the Ontario Ministry of Health and Long-term Care. METHODS Individuals hospitalized for their first SCI between the years 2005 and 2011 were identified and their health care costs were calculated using Ontario administrative health care data. From this information, lifetime costs were estimated using phase-based costing methods. The spinal cord injured cohort was matched to a non-spinal cord injured using propensity score matching. Net costs were determined by calculating the difference in costs between the two matched groups. Net costs were also presented for subgroups stratified by demographic characteristics. RESULTS A total of 1,716 individuals with SCI were identified and matched in our study. The net lifetime cost of SCI was $336,000 per person. Much of the costs were observed in the first year post-SCI. The lifetime cost of SCI for individuals with a concurrent pressure ulcer at the initial hospitalization rises to $479,600. Costs were also higher for individuals with cervical or thoracic injury or requiring inpatient rehabilitation. CONCLUSIONS Spinal cord injury is a substantial burden to the health care system. Our results are limited to the direct health care costs from the publicly funded health care payer perspective. Further analysis with a broader perspective is needed to understand the full economic impact of this catastrophic condition.
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Affiliation(s)
| | - Suzanne M. Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Murray D. Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
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New PW, Eriks-Hoogland I, Scivoletto G, Reeves RK, Townson A, Marshall R, Rathore FA. Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:299-312. [PMID: 29339906 DOI: 10.1310/sci2304-299] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | | | - Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Ronald K Reeves
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrea Townson
- GF Strong Rehab Centre, British Columbia, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.,Discipline of Orthopaedics and Trauma, School of Medicine, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan.,Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, Karachi, Pakistan
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Le Fort M, Espagnacq M, Albert T, Lefèvre C, Perrouin-Verbe B, Ravaud JF. Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up. Eur J Public Health 2018; 28:993-999. [DOI: 10.1093/eurpub/cky084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Marc Le Fort
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Maude Espagnacq
- IRDES – Institute for Research and Documentation in Health Economics, Paris, France
| | | | - Chloë Lefèvre
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Brigitte Perrouin-Verbe
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Jean-François Ravaud
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- CERMES3, INSERM, CNRS, EHESS, Université Paris Descartes, Villejuif, France
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