Economic Analysis of Severe TBI Treatment in Uganda

Although the majority of the global burden of disease occurs in low- and middle-income countries, there is a paucity of data surveillance and analysis on the incidence of, morbidity and mortality associated with, and economic costs attributable to traumatic brain injury (TBI).Methods: A prognostic model was used to estimate outcomes of conservative and neurosurgical treatment for severe TBI based on data from a cohort of patients at the national referral hospital, Mulago Hospital, in Uganda during a 13-month study period. To evaluate the long-term impact of treatment for severe TBI, averted DALYs were calculated and converted to dollars using the human capital and the value of a statistical life (VSL) approaches. This cohort was then used as a representative sample for assessing the benefit of treating severe TBI for all of Uganda.Results: During the study period, 127 cases of severe TBI were treated 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 of intervention ranged from $1.3 million to $1.7 million. The VSL approach estimated an economic benefit of $282,902 to over $11 million. The health benefit of treating severe TBI for all Ugandans was estimated at between about 11,000 and 17,000 averted DALYs per year with an annual potential economic benefit of $15 to $20 million as determined with the human capital approach and $3.3 to $130 million with the VSL approach.Discussion: Treatment of severe TBI in Uganda has the potential to reduce a significant proportion of morbidity, mortality, and economic burden, which indicates the importance of treating severe TBI in developing countries.