The direct medical cost of managing traumatic brain injuries at Port Moresby General Hospital, Papua New Guinea: a prospective cost of illness study
Walter Paka A , Ian Umo B * , Esther Apuahe A and Benjamin Thomas AA
B
Abstract
Traumatic brain injury (TBI) is a major economic and public health problem globally. There is currently no literature on the direct medical cost of TBIs in Papua New Guinea that can guide policymakers on the burden of TBIs. As such, the aim of this study was to calculate the direct medical cost of managing TBI patients at the Port Moresby General Hospital (PMGH).
A prospective cost of illness study was carried out at the PMGH from 31 August 2023 to 1 January 2024. The study included 77 patients: 52 with mild head injuries, 16 with moderate head injuries, and 9 with severe head injuries. A bottom-up approach was employed to estimate direct medical costs from both the patient and hospital perspectives.
Over the 6-month period, the total direct medical cost amounted to K6,246,779.25 (US$1,561,694.81). On average, the direct medical cost per patient was K81,127.00 (US$20,281.75), with a standard deviation of ±341. Alcohol-related injuries accounted for 76.6% (n = 59) of total admissions. Hospital costs during the study period totalled K6,197,919.25 (US$1,549,479.81), representing 99.2% of the total direct medical costs associated with TBIs. Severe head injuries incurred the highest cost per TBI classification, averaging K95,328.03 (US$23,832.01) per patient, with a standard deviation of ±255.
TBIs are a common cause of admission to PMGH and are associated with significant direct medical costs. Public health interventions and government policies should focus on regulating alcohol production and consumption, as well as improving road traffic safety, to reduce the economic burden of TBIs.
Keywords: direct medical cost, health economics, neuro-surgery, Papua New Guinea, Port Moresby General Hospital, public health, trauma, traumatic brain injury.
References
1 Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018; 130(4): 1080-1097.
| Crossref | Google Scholar | PubMed |
2 Huang XF, Ma SF, Jiang XH, Song RJ, Li M, Zhang J, Sun TJ, Hu Q, Wang WR, Yu AY, Li H. Causes and global, regional, and national burdens of traumatic brain injury from 1990 to 2019. Chin J Traumatol 2024; 27(6): 311-322.
| Crossref | Google Scholar | PubMed |
3 Van Dijck J, Dijkman MD, Ophuis RH, de Ruiter G, Peul WC, Polinder S. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS One 2019; 14: e0216743.
| Crossref | Google Scholar | PubMed |
4 GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18: 56-87.
| Crossref | Google Scholar | PubMed |
5 Kaptigau WM, Rosenfeld JV, Kevau I, Watters DA. The Establishment and Development of Neurosurgery Services in Papua New Guinea. World J Surg 2016; 40: 251-257.
| Crossref | Google Scholar | PubMed |
6 Umo I, James K, Didilemu F, Sinen B, Borchem I, Inaido D, Ikasa R. The direct medical cost of trauma etiologies and injuries in a resource limited setting of Papua New Guinea: A prospective cost of illness study. Lancet Reg Health West Pac 2022; 20: 100379.
| Crossref | Google Scholar | PubMed |
8 Fautrel B, Boonen A, de Wit M, et al. Cost assessment of health interventions and diseases. RMD Open 2020; 6: e001287.
| Crossref | Google Scholar | PubMed |
9 Umo I, James K. The direct medical cost of acute appendicitis surgery in a resource-limited setting of Papua New Guinea. World J Surg 2021; 45: 3558-3564.
| Crossref | Google Scholar | PubMed |
10 Shrime MG. Getting costs right in global surgery. World J Surg 2021; 45: 3565-3566.
| Crossref | Google Scholar | PubMed |
11 Papua New Guinea Medical and Dental Health Catalogue. National Department of Health, 10th edn. 2012. Available at https://drive.google.com/uc?export=download&id=1OIJFZvSQ8STYTrP1UBSUDQ2NREdYFvBK [cited 2024].
12 Umo I, Silihtau S, James K, Samof L, Ikasa R, Commons R. An epidemiological and clinical study of Traumatic Brain Injury in Papua New Guinea managed by General Surgeons in Two Provincial Hospital. Indian J Surg 2023; 85: 868-875.
| Crossref | Google Scholar |
13 Liko O, Chalau P, Rosenfeld JV, Watters DA. Head injuries in Papua New Guinea. PNG Med J 1996; 39: 100-104.
| Google Scholar | PubMed |
14 Kaptigau WM, Ke L, Rosenfeld JV. Open depressed and penetrating skull fractures in Port Moresby General Hospital from 2003 to 2005. PNG Med J 2007; 50: 58-63.
| Google Scholar | PubMed |
15 Asa H. Road Traffic Injuries at the Orthopedic unit, Port Moresby General Hospital. 2019. Available at https://devpolicy.org/2019-PNG-Update/Presentations/Parallel-2C-Road-traffic-injuries-at-the-orthopaedic-unit-Henao-Asa.pdf
16 Rubin R. Traumatic Brain Injury Hospital Stays Are Longer, More Costly. JAMA 2020; 323(20): 1998.
| Crossref | Google Scholar | PubMed |
17 Weil ZM, Corrigan JD, Karelina K. Alcohol Use Disorder and Traumatic Brain Injury. Alcohol Res 2018; 39(2): 171-180.
| Google Scholar | PubMed |
19 Pumuye GM, Kuman J. The Need for Law Reform in Papua New Guinea: Part 1. Canberra: Australian National University; 2020 [cited 2025 Jun 16]. Available from https://openresearch-repository.anu.edu.au/server/api/core/bitstreams/bb7ace1c-9bf4-4f36-bf84-bb6b9dd9d4cf/content
20 Asante A, Price J, Hayen A, Jan S, Wiseman V, Jan V. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses. PLoS One 2016; 11(4): e0152866.
| Crossref | Google Scholar | PubMed |
21 James K, Borchem I, Talo R, Aihi S, Baru H, Didilemu F, Moore EM, McLeod E, Watters DA. Universal access to safe, affordable, timely surgical and anaesthetic care in Papua New Guinea: the six global health indicators. ANZ J Surg 2020; 90: 1903-1909.
| Crossref | Google Scholar | PubMed |
22 Kaptigau WM. A practical approach to the management of head injuries in Papua New Guinea. P N G Med J 2007; 50(1–2): 77-86.
| Google Scholar | PubMed |
23 Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surgical Clinics of North America 2017; 97(5): 1015-1030.
| Crossref | Google Scholar |