Spine Journal - 2026-06-09 - Journal Article
The Value of Recovery After Spinal Cord Injury: Long-Term Healthcare Costs in Relation to Home Time in a Population-Based Cohort.
Lozano CS, Karthikeyan V, Haas B, Liu N, Pedro KM, Shakil H, Malhotra AK, Saini J, Fehlings MG, Wilson JR
Topics
Key Takeaway
Five-year cumulative healthcare costs after traumatic SCI reached a median of CA$204,924, ranging from $440,383 for complete cervical to $191,273 for incomplete lumbar injuries, with each 100 additional days alive and at home reducing two-year costs by 10%.
Summary Depth
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Summary
This population-based Ontario cohort quantified five-year direct healthcare costs and healthcare value—defined as cost relative to days alive and at home (DAH-2y)—across SCI injury phenotypes. Costs were front-loaded (median CA$78,572 in the first 30 days, <$10,000/year after year 1), and complete cervical injuries cost 2.3× more than incomplete lumbar injuries over five years. Greater DAH-2y independently predicted lower costs (cost-ratio 0.90 per 100 days; p<0.001), and each FIM motor score point gained in rehabilitation reduced one-year costs by 0.86%.
Key Limitation
The study captures only direct provincial healthcare costs and excludes out-of-pocket expenses, informal caregiver costs, and productivity losses, likely underestimating the true societal economic burden—particularly for younger complete cervical injury patients.
Original Abstract
BACKGROUND
Traumatic spinal cord injury (SCI) is associated with substantial long-term healthcare utilization. While prior studies have quantified costs, few have contextualized expenditures in relation to patient-centered recovery and healthcare value.
PURPOSE
To characterize five-year longitudinal healthcare cost following traumatic SCI, estimate phenotype-specific cost trajectories, and evaluate healthcare value by integrating costs with days alive and at home (DAH).
STUDY DESIGN/SETTING
Population-based retrospective cohort study using linked administrative health data from Ontario, Canada.
PATIENT SAMPLE
Adults (≥18 years) presenting to trauma centers with acute traumatic SCI between 2009 and 2023 (n=614).
OUTCOME MEASURES
Total direct healthcare costs over five years; DAH within two years (DAH-2y); change in Functional Independence Measure (FIM) motor score during inpatient rehabilitation.
METHODS
Multi-sector healthcare costs were ascertained from provincial single-payer records using validated person-level costing algorithms. Longitudinal costs were modeled using generalized estimating equations with a gamma distribution and log link. Five-year phenotype-specific population-averaged costs were estimated via marginal standardization. Healthcare value was assessed by integrating two-year costs with DAH-2y using cost-per-DAH metrics and modeling of the association between DAH and total costs using multivariable gamma regression. Associations between FIM motor improvement and costs were also evaluated.
RESULTS
Healthcare spending was heavily front-loaded, with median total costs of CA$78,572 in the first 30 days following SCI and declining to < $10,000 annually after year 1. Median five-year cumulative costs were $204,924 (interquartile range [IQR] $112,357-$367,952). Adjusted five-year population-averaged costs varied substantially by phenotype, ranging from $440,383 for complete cervical injuries to $191,273 for incomplete lumbar injuries. Cost differentials by injury completeness were most pronounced within the first two years and attenuated thereafter. Median DAH-2y was 603 days (IQR 229-664). Greater DAH-2y was independently associated with lower two-year costs (10% reduction per 100 additional days; cost-ratio 0.90, 95% CI 0.87-0.92; p<0.001). Among patients with DAH>0, median spending intensity was $268 per DAH (IQR $155-$515) and varying by phenotype ($577 per DAH for complete cervical vs $228 for incomplete cervical injuries). Greater improvement in FIM motor score was independently associated with lower one-year costs (0.86% reduction per point; p<0.001).
CONCLUSIONS
Long-term healthcare expenditures after traumatic SCI vary substantially by injury phenotype and are concentrated early after injury. Integrating costs with DAH and functional recovery reframes resource use through a value-based lens relative to patient-centered outcomes.