A Systematic Review of the Impact of Spinal Cord Injury on Costs and Health-Related Quality of Life

Abstract

Objective: 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.

Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was conducted in March 2021 through Scopus, PubMed and Embase databases. Inclusion criteria were quantitative studies on SCI reporting healthcare costs, social costs and/or HRQoL measured with the Euroqol EQ-5D or Short-Form 36. Risk of bias was assessed using the QualSyst tool. 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 US$0.7 million to US$2.5 million, with greater costs associated with earlier age at injury, neurological level, United States of America healthcare setting and the inclusion of non-healthcare items in the study.

Conclusions: SCI is 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. SCI is associated with high costs which vary by country.

Clinical trials registration: This review was registered in PROSPERO (registration number: CRD42021235801).

Fig. 1

Prisma

Fig. 2

Costs per injured person (price in US dollars 2023). The size of the point is proportional to the log of the sample size: C1–C7 tetraplegic, C1–C4 high tetraplegic, C5–C8 low tetraplegic, T1–T12 paraplegic (paralysis in the thoracic area), T7–L1 paraplegia (affecting abdominal area), L2–S5 paraplegia (paralysis of lumbar and sacral area) and T1–S5 paraplegia (paralysis in the thoracic, lumbar and sacral area)