Indirect Cost of Traumatic Brachial Plexus Injuries in the United States
Christopher Dy, MD, MPH1; Thomas Hong, MS, MD1; Andrea Tian, MD1; Ryan Sachar, BS1; Wilson Z Ray, MD1; David M Brogan, MD, MSc2
1Washington University School of Medicine, St. Louis, MO, 2Washington University in St. Louis, St. Louis, MO
HYPOTHESIS: Traumatic brachial plexus injuries (BPI) disproportionately affect young, able-bodied patients. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI.
METHODS: We estimated indirect costs as the sum of (1) short-term wage losses; (2) long-term wage losses; and (3) disability payments. Short-term (6 month) wage losses were the product of missed work days and average earnings per day. Probability of return to work was derived from a systematic review and long-term wage losses and disability payments were es-timated. Monte Carlo simulation was used to perform a sensitivity analysis of long-term wage losses by varying age and gender simultaneously. Disability benefits were estimated from the Social Security Administration. All cost estimates are in 2018 US dollars.
RESULTS: A systematic review demonstrated that the mean age of BPI patients is 26.4 years, 91% are male, and the most-represented occupation is manual labor. Based on these de-mographics, our base case was a 26 year-old American man working as a manual laborer prior to BPI, with an annual wage of $36,590. The Monte Carlo simulation estimates the short-term wage losses as $22,740, long-term wage losses as $813,652, and disability benefits as $384,606. The total indirect cost of traumatic BPI was $1,220,998 per patient over the post-injury life-time. If the probability of the patient returning to the workforce in a different, lower-paying job is doubled, perpatient total indirect cost is $867,987.
CLINICAL RELEVANCE: BPI can have far-reaching economic impact on both individuals and society. Efforts to improve outcomes after surgical reconstruction will likely aid in return-ing individuals to the workforce, which can decrease the indirect cost dramatically.
LEVEL OF EVIDENCE: Economic Level IV
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