Economic burden and cost drivers of traumatic brain injury

Traumatic brain injury (TBI) is a significant public health concern in low-income countries. This study assesses the economic burden of TBI in Togo, estimating both direct and indirect costs and identifying key cost drivers.

We conducted a cross-sectional study at CHU Sylvanus Olympio in Lomé from January to December 2022, including patients with complete medical and financial records. Direct medical costs included expenditures directly related to hospital-based medical care from admission to discharge, consultation fees, laboratory investigations, radiological examinations, medications, surgical procedures, intensive care charges, and hospitalization fees. Indirect costs included nonmedical and productivity-related expenses incurred during hospitalization: transportation, food, communication expenses, and loss of income for both patients and caregivers due to missed workdays.

A total of 219 patients were analyzed (mean age 37.3 ± 14.1 years; 81.7% male). Road traffic accidents accounted for 86.7% of TBIs, with motorcycles involved in the vast majority. The median total cost of care was USD 512 (IQR: 380-890), and the mean cost was USD 648 ± 478 - approximately 7.1 times the national monthly minimum wage. Direct medical costs constituted the largest share of expenditures, particularly treatment-related items. Intensive care unit admission, surgical intervention, and longer hospital stay were all significantly associated with higher total costs (p < 0.005).

TBI management imposes a substantial financial burden in this tertiary hospital setting in Togo. Resource-intensive care, particularly surgery, intensive care admission, and longer hospital stay, significantly increases costs. Broader studies are needed to assess the full national and long-term economic burden of TBI. The financial burden of TBI management in our setting is considerable, particularly given limited health insurance coverage. TBI management imposes a substantial economic burden in this tertiary hospital setting, with costs significantly driven by intensive care admission, surgical intervention, and prolonged hospitalization.