Medical and productivity costs after trauma

Autoři: A. J. L. M. Geraerds aff001;  Juanita A. Haagsma aff001;  L. de Munter aff002;  N. Kruithof aff002;  M. de Jongh aff002;  Suzanne Polinder aff001
Působiště autorů: Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands aff001;  Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227131



Well-advised priority setting in prevention and treatment of injuries relies on detailed insight into costs of injury. This study aimed to provide a detailed overview of medical and productivity costs due to injury up to two years post-injury and compare these costs across subgroups for injury severity and age.


A prospective longitudinal cohort study followed all adult (≥18 years) injury patients admitted to a hospital in Noord-Brabant, the Netherlands. Patients filled out questionnaires 1 week, 1, 3, 6, 12 and 24 months after trauma, including items on health care consumption from the medical consumption questionnaire (iMCQ) and productivity loss from the productivity cost questionnaire (PCQ). Furthermore, injury severity was defined by Injury Severity Score (ISS). Data on diagnostics was retrieved from hospital registries. We calculated medical costs, consisting of in-hospital costs and post-hospital medical costs, and productivity costs due to injury up to two years post-injury.


Approximately 50% (N = 4883) of registered patients provided informed consent, and 3785 filled out at least one questionnaire. In total, the average costs per patient were €12,190. In-hospital costs, post-hospital medical costs and productivity costs contributed €4810, €5110 and €5830, respectively. Total costs per patient increased with injury severity, from €7030 in ISS1-3 to €23,750 in ISS16+ and were lowest for age category 18-24y (€7980), highest for age category 85 years and over (€15,580), and fluctuated over age groups in between.


Both medical costs and productivity costs generally increased with injury severity. Furthermore, productivity costs were found to be a large component of total costs of injury in ISS1-8 and are therefore a potentially interesting area with regard to reducing costs.

Klíčová slova:

Age groups – Elderly – Head injury – Health economics – Hospitals – Spinal cord injury – Traumatic brain injury – Traumatic injury


1. Morrison A, Stone D.H., EURORISC working group. Injury mortality in the European Union 1984–1993. Eur J Public Health. 2000;10:201–7.

2. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349(9063):1436–42. doi: 10.1016/S0140-6736(96)07495-8 9164317

3. Polinder S, Meerding WJ, van Baar ME, Toet H, Mulder S, van Beeck EF, et al. Cost estimation of injury-related hospital admissions in 10 European countries. J Trauma. 2005;59(6):1283–90; discussion 90–1. doi: 10.1097/01.ta.0000195998.11304.5b 16394898

4. McGarry LJ, Thompson D, Millham FH, Cowell L, Snyder PJ, Lenderking WR, et al. Outcomes and costs of acute treatment of traumatic brain injury. J Trauma. 2002;53(6):1152–9. doi: 10.1097/00005373-200212000-00020 12478043

5. Scholten AC, Haagsma JA, Panneman MJ, van Beeck EF, Polinder S. Traumatic brain injury in the Netherlands: incidence, costs and disability-adjusted life years. PLoS One. 2014;9(10):e110905. doi: 10.1371/journal.pone.0110905 25343447

6. Dias JJ, Garcia-Elias M. Hand injury costs. Injury. 2006;37(11):1071–7. doi: 10.1016/j.injury.2006.07.023 17045996

7. Dryden DM, Saunders LD, Jacobs P, Schopflocher DP, Rowe BH, May LA, et al. Direct health care costs after traumatic spinal cord injury. J Trauma. 2005;59(2):464–7. doi: 10.1097/01.ta.0000174732.90517.df 16294090

8. Meerding WJ, Mulder S, van Beeck EF. Incidence and costs of injuries in The Netherlands. Eur J Public Health. 2006;16(3):272–8. doi: 10.1093/eurpub/ckl006 16476683

9. Harlan LC, Harlan WR, Parsons PE. The economic impact of injuries: a major source of medical costs. Am J Public Health. 1990;80(4):453–9. doi: 10.2105/ajph.80.4.453 2138429

10. MacKenzie EJ, Weir S, Rivara FP, Jurkovich GJ, Nathens AB, Wang W, et al. The value of trauma center care. J Trauma. 2010;69(1):1–10. doi: 10.1097/TA.0b013e3181e03a21 20622572

11. Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and lifetime costs of injuries in the United States. Inj Prev. 2006;12(4):212–8. doi: 10.1136/ip.2005.010983 16887941

12. Velopulos CG, Enwerem NY, Obirieze A, Hui X, Hashmi ZG, Scott VK, et al. National cost of trauma care by payer status. J Surg Res. 2013;184(1):444–9. doi: 10.1016/j.jss.2013.05.068 23800441

13. de Jongh MA, Kruithof N, Gosens T, van de Ree CL, de Munter L, Brouwers L, et al. Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study. Inj Prev. 2017;23(1):59. doi: 10.1136/injuryprev-2016-042032 27154507

14. Baker SP, O'Neill B, Haddon W Jr., Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96. 4814394

15. Gennarelli TA, Wodzin E. Abbreviated Injury Scale 2005: Update 2008. Barrington: Association for the Advancement of Automotive Medicine; 2008.

16. Bouwmans C, Hakkaart- van Roijen L, Koopmanschap M, Krol M, Severens H, Brouwer W. Handleiding iMTA Medical Cost Questionnaire (iMCQ): Rotterdam: iMTA, Erasmus Universiteit Rotterdam; 2013 [Available from:

17. Hakkaart-van Roijen L, van der Linden N., Bouwmans C., Kanters T., Tan S.S. Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg2015.

18. Erasmus MC. Passantenprijslijst 2016 2016 [Available from:

19. Nederlandse Zorgautoriteit. BRCU -2015 Bijlage 2 Medisch specialistische behandelingen en tarieven 2011 2015 [Available from:

20. Nederlandse Zorgautoriteit. Nederlandse Zorgautoriteit zorgapplicatie 2017 [Available from:

21. Elkerliek. Standaard prijslijst overige zorgproducten 2013 [Available from:

22. Nederlandse Zorgautoriteit. Tarievenlijst Eerstelijnsdiagnostiek 2014 [Available from:

23. Rivas. Bio-impedantiemeting 2019 [Available from:

24. Zeelandcare. Passanten prijslijst DBC-OVP zorgproducten 2018 [Available from:

25. Upatising B, Wood DL, Kremers WK, Christ SL, Yih Y, Hanson GJ, et al. Cost comparison between home telemonitoring and usual care of older adults: a randomized trial (Tele-ERA). Telemed J E Health. 2015;21(1):3–8. doi: 10.1089/tmj.2014.0021 25453392

26. Bouwmans C, Krol M, Severens H, Koopmanschap M, Brouwer W, Hakkaart-van Roijen L. The iMTA Productivity Cost Questionnaire: A Standardized Instrument for Measuring and Valuing Health-Related Productivity Losses. Value Health. 2015;18(6):753–8. doi: 10.1016/j.jval.2015.05.009 26409601

27. CBS. Working population; Working time 2019 [Available from:

28. Polinder S, Haagsma J, Panneman M, Scholten A, Brugmans M, Van Beeck E. The economic burden of injury: Health care and productivity costs of injuries in the Netherlands. Accid Anal Prev. 2016;93:92–100. doi: 10.1016/j.aap.2016.04.003 27177394

29. Belmont PJ Jr., Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134(5):597–604. doi: 10.1007/s00402-014-1959-y 24570142

30. CBS. Hoogst behaald onderwijsniveau 2017 [Available from:

Článek vyšel v časopise


2019 Číslo 12