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Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years
  1. Wei-Chih Lien1,2,3,
  2. Wei-Ming Wang4,
  3. Fuhmei Wang5,6,
  4. Jung-Der Wang6,7
  1. 1 Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  2. 2 Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  3. 3 Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan
  4. 4 Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
  5. 5 Department of Economics, National Cheng Kung University, Tainan, Taiwan
  6. 6 Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  7. 7 Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  1. Correspondence to Dr Jung-Der Wang, Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; jdwang121{at}gmail.com

Abstract

Background The objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan.

Methods From the claims database of Taiwan National Health Insurance, we identified 6164 adult patients with newly diagnosed SCI with permanent functional disability from 2000 to 2015 and followed them until the end of 2016. We estimated survival function through the Kaplan-Meier method and extrapolated it to lifetime.

Results For the SCI cohort, the LE and loss-of-LE were 17.6 and 13.3 years, respectively, while those for SCI with coding of external causes (E-code) were 18.1 and 13.0 years, respectively. For the SCI cohort with E-code, the loss-of-LE of motor vehicle (MV)-related SCI was significantly higher than that of fall-related SCI. In young and middle-aged patients with SCI with E-code, the loss-of-LE of MV-related paraplegia was significantly higher than that of MV-related quadriplegia and fall-related SCI. With a 3% discount rate, the LMC for patients with SCI after diagnosis were US$82 772, while those for patients with SCI with E-code were US$81 473. The LMC and the cost per year for those living with quadriplegia were significantly higher than those for paraplegia in all age groups, possibly related to the higher frequencies of stroke, chronic lung disease and dementia.

Conclusions We conclude that quadriplegia has a higher impact on medical costs than paraplegia, and MV-related SCI has a higher impact on loss-of-LE than fall-related SCI. We recommend comprehensive SCI prevention be established, including infrastructures of construction and transportation.

  • spinal cord injury
  • cohort study
  • economic analysis
  • longitudinal
  • burden of disease
  • costs

Data availability statement

Data are accessible through the Institutional Review Board (IRB) of the National Cheng Kung University Hospital (NCKUH) for researchers who meet the criteria to access confidential data for academic purposes with a permission letter. The IRB of NCKUH is entitled and has full rights to oversee all activities of each researcher, to comply with the Personal Data Protection Act. Anyone who is interested in analysing the same data set must write a research proposal with full protection of human rights and apply to the IRB of NCKUH to get access. Accompanied with the approval letter from the ethics committee of the researcher’s institution and the research proposal, the researcher can email the application to the Collaboration Center of Health Information Application, Ministry of Health and Welfare to access the data.

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Data availability statement

Data are accessible through the Institutional Review Board (IRB) of the National Cheng Kung University Hospital (NCKUH) for researchers who meet the criteria to access confidential data for academic purposes with a permission letter. The IRB of NCKUH is entitled and has full rights to oversee all activities of each researcher, to comply with the Personal Data Protection Act. Anyone who is interested in analysing the same data set must write a research proposal with full protection of human rights and apply to the IRB of NCKUH to get access. Accompanied with the approval letter from the ethics committee of the researcher’s institution and the research proposal, the researcher can email the application to the Collaboration Center of Health Information Application, Ministry of Health and Welfare to access the data.

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Footnotes

  • Contributors W-CL, W-MW, FW and J-DW designed the study protocols. W-CL, W-MW, FW and J-DW collected the data. Data analysis and interpretation were performed by W-CL, W-MW, FW and J-DW. W-CL wrote the manuscript under the supervision of J-DW. W-CL, W-MW, FW and J-DW contributed significantly to revising the manuscript. All authors read and approved the final manuscript.

  • Funding We are grateful to the Ministry of Science and Technology, Taiwan, for funding this research under MOST 106-2314-B-006-017-MY3, MOST 108-2314-B-006-015, MOST 107-2627-M-006-007, and MOST 108-2627-M-006-001. We are grateful for grants from National Cheng Kung University Hospital (NCKUH-11004013).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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