Indirect Cost of Traumatic Brachial Plexus Injuries in the United States

Level 4 Evidence
      Grant support received from: UL1 TR000448, Sub award KL2 TR000450 from the NIH-National Center for Advancing Translational Sciences (NCATS), components of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research


      Consulting Fee: Globus Medical, DePuy Synthes (Ray)
      Speaker's Bureau: Arthrex, TriMed (Brogan)
      Contracted Research: AxoGen (Brogan)


      Traumatic brachial plexus injuries (BPI) pose a significant economic burden to the United States health care system, as they disproportionately affect young, able-bodied patients. Beyond the direct costs associated with medical treatment, there are far-reaching indirect costs for BPI patients relating to workforce productivity that have not yet been estimated. Our objective was to estimate the per-patient indirect cost associated with traumatic BPI.


      We performed a systematic review of the BPI literature to establish the demographics of BPI patients. We then estimated indirect costs as the sum of (1) short-term wage losses, (2) long-term wage losses, and (3) disability payments. Short-term (6-month) work losses were calculated as the product of missed workdays and the average earnings per day accounting for fringe benefits, based on data from the Bureau of Labor Statistics. Long-term work losses were estimated using a combination of permanent total and partial disabilities using the results of a literature review. Disability benefits paid were estimated using the Social Security Administration (SSA) online calculator. Monte-Carlo simulation was used to perform a sensitivity analysis of long-term work losses by varying age and gender simultaneously (according to demographics reported in the literature). All cost estimates are made in 2017 dollars.


      A systematic review and pooled analysis of demographics among the international BPI literature demonstrated that patients had a mean age of 26.9 ± 3.7 years and were 90% male. The most represented occupation category was manual labor. Based on these demographics, our base case was a 27-year-old man working as a manual laborer prior to the BPI. Mean annual wage for a manual laborer was estimated as $34,850. Short-term work losses (including fringe benefits) were estimated as $22,380. Controlling for gender and age of onset of BPI, long-term wage losses resulting from total disability were estimated from the Monte-Carlo simulation to be $1,537,300. Monthly disability benefits (collected from age 28–67) at this annual wage level after 9 years in the workforce were estimated as $1,591. For this base case, total indirect cost of traumatic BPI was $2,342,452 (in 2017 dollars) over the course of a post-injury lifetime.

      Summary Points

      • We estimate that the per-patient indirect cost of traumatic BPI is $2.34 million (in 2017 dollars) over a lifetime.
      • BPI is associated with a substantial indirect cost over a lifetime, justifying increased allocation of resources to return patients to function and employment.


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