Economic and Financial Burden of Traumatic Brain Injury Care in Low- and Middle-Income Countries: A Scoping Review

When a person suffers a traumatic brain injury, the immediate crisis is physical: the brain has been damaged, and the body needs urgent medical attention. But for families in low- and middle-income countries, the crisis extends far beyond the hospital walls. It becomes a financial storm that can sweep away savings, force the sale of family assets, and leave caregivers unable to work. This is the reality of traumatic brain injury in regions where health systems are often stretched thin and households have little money to spare. The injury itself is a leading cause of death and disability worldwide, but in these settings, the cost of treating it can be just as devastating as the injury. The question researchers have long struggled to answer is not just how much it costs to fix a broken bone or repair a skull, but how that cost ripples through a family's life, a community's economy, and a nation's health budget.

A team of researchers set out to map this hidden landscape of financial burden. They did not look for a single number that could describe the cost of brain injury everywhere, because such a number does not exist. Instead, they gathered every available study from low- and middle-income countries that tried to measure the money spent on these injuries. They looked for reports on hospital bills, the money families pay out of their own pockets, the loss of income when a worker is sick or a caregiver stays home, and the broader cost to society when people cannot work or die too soon. Their goal was to see the full picture of how these injuries strain resources, from the individual patient to the entire health system.

The researchers found twenty studies from fourteen different countries, including nations in Africa, Asia, and the Americas. These studies, published between 2008 and 2026, told a consistent story: the price of care is high, and it rises sharply with the severity of the injury. When a patient needs surgery, intensive care, or long hospital stays, the costs climb. In one study in Benin, the average cost for a patient with a mild injury was significantly lower than for a patient with a severe injury, which cost more than double. In Malaysia, the average cost for a year of treatment for a surgically managed injury was nearly eight thousand US dollars. In Brazil, a massive analysis of national records showed that public hospitals spent millions of dollars annually just on brain injury admissions. The pattern was clear across the board: more severe injuries required more resources, and those resources came with a steep price tag.

But the financial weight does not stop at the hospital bill. The researchers discovered that families often bear the brunt of the cost through out-of-pocket spending, which means paying directly for services without insurance or government help. In India, a small study found that most families faced costs so high they were considered catastrophic, meaning the expense threatened their ability to meet basic needs like food and shelter. Many families had to borrow money or sell possessions to pay for treatment. In Tanzania, a study of severe brain injuries revealed that nearly a quarter of patients could not pay for their care at all. For these families, the inability to pay did not just mean financial stress; it meant they received less intensive treatment, fewer scans, and sometimes less care overall. The money a family had available directly shaped the quality of medical care they received.

The burden also falls heavily on those who stay behind. When a patient is injured, a family member often stops working to provide care, leading to a double loss of income. In Iran, researchers found that the money lost by families due to missed work and reduced productivity was far greater than the money spent on hospital bills. In some cases, the economic loss from a fatal injury was estimated to be hundreds of times larger than the direct cost of treating the patient in the hospital. This hidden cost of lost time and lost wages is rarely counted in official health budgets, yet it represents a massive drain on the economy. Caregivers, often women, face their own financial strain, spending money on transport, food, and accommodation while losing their own earnings.

Despite these findings, the researchers noted that the picture is still incomplete. Most of the studies focused on the immediate hospital stay, looking at the costs of the first few weeks or months. Very few studies followed patients for years to see how much rehabilitation costs or how long the financial strain lasts after a person leaves the hospital. There is also a lack of data from rural areas and smaller clinics, where many people with injuries are treated. The studies that did exist varied widely in how they counted costs, making it difficult to compare one country to another directly. Some studies counted only hospital bills, while others included transport and food. Some looked at the cost to the government, while others looked at the cost to the family.

The researchers concluded that while we now know that traumatic brain injury creates a heavy financial burden in low- and middle-income countries, we still need better ways to measure it. To protect families from financial ruin and to plan better health systems, future studies must look beyond the hospital and track costs over a longer time. They need to include the cost of rehabilitation, the loss of income for caregivers, and the long-term impact on society. Until then, the evidence suggests that for many families in these regions, a brain injury is not just a medical emergency, but a financial one that can change the course of their lives forever. The data shows that without financial protection and better resource planning, the cost of care will continue to fall hardest on those who can least afford it.