Hello, I'm Aaron Yango-Khan. I'm thrilled to talk to you about the cost of a concussion in American high school football. We have no relevant disclosures. Sport-related concussion is exceedingly common for young athletes, and especially male high school football players, of whom one in five is concussed each year. Prior studies have estimated over $1 billion in tackle football-associated health care costs between 2010 and 2013. But while these costs include all injuries, there are only emergency department and inpatient-associated costs and do not include outpatient costs or the costs of prevention. The costs of sport concussion are almost entirely unknown, and these are comprised of the costs that go towards prevention, for example, $170 million annually being spent on helmets, the direct costs of health care itself, those costs going to clinic, therapy, and acute care, and indirect costs such as those associated with decrements in health-related quality of life after concussion. For this project, we focused on the direct health care costs associated with one episode of concussion. Our objectives were to one, describe the health care costs associated with a football-related concussion, and two, to determine what clinical factors are most associated with increased costs. We hypothesized that the development of post-concussion syndrome or recovery taking longer than 28 days would be particularly associated with higher costs. We conducted a retrospective cohort study of concussed high school football players seen at our concussion clinic between 2017 and 2020. Our exclusion criteria was designed to focus on athletes receiving the majority of care at our center, and we excluded those with delayed presentation or those lost to follow-up. We defined a care episode as the injury through clinic discharge or through total symptom resolution. The primary outcome was cost per concussion in 2017 U.S. dollars. We used line-by-line costs, not charges, matched to visit and imaging data to determine these costs. We included 144 concussed football players. All were male with a median age of 16. Players were generally mild to moderately symptomatic at presentation with a median post-concussion symptom scale score of 11. The vast majority reached clinical endpoints prior to discharge from the clinic, although 6 were discharged while still mildly symptomatic. They recovered and returned to school and sports in timeframes comparable to those in the literature. The average cost of a concussion was $800, and most had between 1 and 3 health care contacts during the course of care. Over a quarter received acute care in the emergency department or urgent care, but only about 13% received imaging. We performed a multiple linear regression to determine what factors were the most relevant drivers of cost. These included initial symptom burn, visiting the emergency department, and developing post-concussion syndrome. This chart demonstrates the relationship between initial symptom burn and total costs, where increasing symptoms were associated with increasingly greater total costs. Also note that the blue triangles representing athletes that develop post-concussion syndrome are clustered towards higher symptom burdens and higher total costs. Now that we have started to understand the cost of a concussion, we can begin to consider more complex ideas in concussion care and science, such as treatment and prevention cost effectiveness. Questions like, is a helmet cost effective? We can inform stakeholder decision making and raise awareness of the factors that influence the cost of a concussion and even simply that costs do exist. As concussion research suggests more treatments and more intensive treatment, we have to recognize the potential for uninhibited cost expansion if we do not consider cost effectiveness together with innovation.

cost of concussions

American high school football

healthcare costs

football-related concussion

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