Cost of motorcycle crash victims at a public tertiary healthcare Facility in Karachi, Pakistan: A cross-sectional study/

Injuries are major preventable public health concern globally and in low and middle-income countries. Road traffic injuries account for the major proportion of injury burden. However, motorcyclists are the most vulnerable group to sustain fatal and non-fatal injuries. Moreover, they are highly prone to traumatic brain injuries (TBI). The use of helmet is one of most acknowledged protective measure against TBI among motorcyclists. Furthermore, helmet use significantly reduces TBI severity and consequently healthcare costs. Objectives: To estimate the difference in the healthcare cost of motorcycle crash injuries in those who were wearing helmet and those who were not wearing helmet from ER admission until discharge in Karachi, Pakistan, Pakistan. Methodology: The research design is cross-sectional study. For cost estimation, we used micro-costing and out-of-pocket expenditure data collection. The study is conducted in a public tertiary hospital of Karachi, Pakistan. We included 18 year and above victims of motorcycle crash both riders and pillions. We used Consecutive sampling strategy to collect data related to direct healthcare costs among helmeted and non-helmeted victims of motorcycle crashes. Results: We recruited 323 participants. 193 (60%) were not wearing helmet while 127 (39%) were wearing helmet at the time of crash, whereas the rest of participants did not remember helmet practice. In non-helmeted group, 46% had head injury while in helmeted group 18% had head injuries. Most of the participants were young males (94%). Moreover, there was substantial difference in the total healthcare cost among those who were wearing help et median healthcare cost of Rs.91229 while helmeted group has lesser cost Rs.15855. However, the cost is much higher in those victims with traumatic brain injury (TBI) which is Rs.477610 per victim as compared to Rs.4562 in those without TBI. Furthermore, the out-of-pocket (OOP) is also noticeably higher in non-helmeted group (Rs.16800) compared to Rs. 1250 in those who were wearing helmet. Conclusion: In this study we conclude that motorcycle crashes can impose substantial healthcare cost on our health system. The cost is noticeably higher in those who were not wearing helmet as compared to helmet users. Moreover, we found that the frequency of traumatic brain injury (TBI) is higher in nonhelmeted motorcycle victims as compared to helmeted. This consequently increases the healthcare cost as TBI patients consumed more healthcare services in surgical, radiological and hospital stay cost centers. Furthermore, although the study site was public sector, where care services were free of cost, still the patients had substantially higher OOP which was two times the median monthly income of the participants