American Society for Peripheral Nerve

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Direct Cost of Surgically-Treated Adult Traumatic Brachial Plexus Injuries
Christopher Dy, MD MPH FACS, Kate Peacock, BS, Margaret A Olsen, PhD, MPH, Wilson Z Ray, MD and David M Brogan, MD, MSc, Washington University School of Medicine, St. Louis, MO

Introduction: Despite primarily affecting young working-age patients, the economic implications of brachial plexus injuries (BPI) in the United States are not well understood. A single study tallied hospitalization charges associated with BPI surgery in one year (2006) using the Nationwide Inpatient Sample. Recent work has estimated the indirect cost of traumatic BPI as $2.34 million per patient, capturing the cost of lost productivity and disability payments from a societal perspective. The purpose of our study was to quantify the direct charges associated with surgical treatment of BPI, which would enable future study of the societal value of surgical reconstruction.

Materials & Methods: Using the Truven Healthcare MarketScan commercial claims database, we assembled a cohort of patients with BPI treated surgically from 2007 to 2015 with one full year of insurance coverage after surgery. We identified the index admission associated with BPI surgery and tabulated all paid claims (including medical, surgical, therapy, and pharmacy claims) through one year after surgery.

Results: Among 170 patients undergoing surgery for BPI, the median direct charges were $35,232.94 (interquartile range was $15,332.74, $61,947.18). The minimum and maximum charges were $3,065.31 and $866,778.69, respectively.

Conclusions: The median direct healthcare charges in the for one year after BPI surgery were $35,233. When adding this to the previously estimated per-person indirect lifetime cost of BPI ($2.34 million), the total economic burden of adult traumatic BPI is $2.38 million per-person. The direct charges of surgical treatment represent 1.5% of the total cost, suggesting that surgery and other interventions to maximize return to work are likely to be cost-effective (and perhaps cost-saving) from a societal perspective.

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