# Out-of-pocket expenditure in patients with isolated traumatic brain injury: a two center cohort study, a preliminary report

## TL;DR

This study examines the financial burden of isolated traumatic brain injuries in India, finding high out-of-pocket costs and significant financial distress for patients.

## Contribution

The study provides preliminary data on out-of-pocket expenditure and financial distress in isolated TBI patients in India.

## Key findings

- The mean out-of-pocket expenditure for isolated TBI was INR 88,485, with high direct and indirect costs.
- 15 out of 18 participants experienced catastrophic health expenditures, and 11 faced distress financing.
- Despite subsidized care, isolated TBI imposes a substantial financial burden on patients.

## Abstract

Traumatic brain injuries (TBI) account for 30–40% of global injury mortality. In India, high out-of-pocket expenditure (OOPE; 58.7% of total health costs) exacerbates catastrophic health expenditures (CHE). This study estimates OOPE, along with the risk of CHE and distress financing, in patients with isolated TBI.

We conducted a prospective cohort study across two centers, enrolling patients with isolated TBI over one month. Direct (medical and non-medical) and indirect (wage loss) costs were recorded using medical diaries. 3 months post discharge rehabilitation expenses were recorded.

Eighteen participants (mean age: 43 years, eleven males) were included; four had health insurance, and seven were primary earners. The mean OOPE was INR 88,485 comprising INR 58,319 in direct and INR 30,166 in indirect costs. CHE was observed in fifteen participants and distress financing in eleven participants.

Despite subsidized care, the substantial OOPE for isolated TBI underscores the financial burden, and the imperative for equitable, sustainable healthcare policies.

The online version contains supplementary material available at 10.1186/s12962-026-00716-1.