A systematic review of the impact of spinal cord injury on costs and health-related quality of life

Abstract

OBJECTIVES To systematically review the health-related quality of life (HRQoL) burden and costs of spinal cord injury (SCI) on health services, patients, and wider society. METHOD A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was conducted through Scopus, PubMed and Embase databases. Descriptive analyses, random-effects direct meta-analysis and random-effects meta-regression were conducted. RESULTS A total of 67 studies were eligible for inclusion. SCI individuals tend to report higher HRQoL in mental than physical dimensions of the Short-Form 36. Neurological level of SCI negatively affects HRQoL. Cross-sectional studies find employment is associated with better HRQoL, but the effect is not observed in longitudinal studies. The estimated lifetime expenditure per individual with SCI ranged from $0.5 million to $2.0 million, with greater costs associated with earlier age at injury, neurological level, United States (US) healthcare setting, and the inclusion of non-healthcare items in the study. CONCLUSION SCI, and neurological level of injury, are associated with low HRQoL on mobility and physical dimensions. Mental health scores tend to be greater than physical scores, and most dimensions of HRQoL appear to improve over time, at least over the first year. These conditions are associated with high costs which vary by country.