Abstract Information


A systematic review on the Health Economics of the spinal cord injury or disease among veterans of war

Furlan J, Gulasingam S, Craven B
Lyndhurst Centre, Toronto Rehabilitation Institute & University of Toronto, Toronto, ON, Canada

Objective: Information on health-care utilization and the economic burden of disease are essential to understanding service demands, service accessibility, and practice patterns. This information may also be used to enhance the quality of care through altered resource allocation. Thus, a systematic review of literature on the economic impact of caring for veterans with SCI/D would be of great value. This study was undertaken to systematically review and critically appraise the literature on the economics of the managements of veterans with spinal cord injury or disease (SCI/D).
Design/Method: Medline, EMBASE and PsycINFO databases were searched for articles on economic impact of management of SCI/D veterans, published from 1946 to September/2016. The search criteria included subject headings (“spinal cord injury” OR “spinal cord injuries”) AND (“trauma” OR “wounds and injuries”) AND (“military” OR “military personnel” OR “war” OR “veterans” OR “combatants” OR “soldiers”). The search was limited to “humans”. Abstracts and, if needed for clarification, actual articles were screened to find original papers that studied the economic impact of management of veterans with SCI/D or cost-effective analyses. Case reports, conference abstracts only, and editorials were excluded. The STROBE statement was used to determine publication quality.
Results: The search identified 1,573 publications, 13 articles fulfilled the inclusion/exclusion criteria with 12 articles focused on costs of management of SCI/D veterans; and, one cost-effectiveness analysis. Overall, the health care costs for the management of veterans with SCI/D are substantial ($30,770 to $62,563 in 2016 USD per year) and, generally, greater than the costs of caring for patients with other chronic diseases. The most significant determinants of the higher total health-care costs are cervical level injury, complete injury, time period (i.e. first year post-injury and end-of-life year), and presence of pressure ulcers.
Conclusion: There is growing evidence for the economic burden of SCI/D and its determinants among veterans, whereas there is a paucity of comparative studies on interventions including cost-effectiveness analyses. The results also highlight that the health care costs of the management of veterans with SCI/D are substantial and, in general, greater than the costs of caring for civilians with SCI and costs of caring for patients with other more common chronic diseases. Further investigations are needed to fulfill significant knowledge gaps on the economics of caring for veterans with SCI/D.
Support: The first author receives salary support from the Wings for Life Spinal Cord Research Foundation


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