Objective This study sought to quantify healthcare costs associated with a sport-related concussion (SRC) and determine factors driving increased costs.

Design Retrospective cohort study.

Setting Regional Sport-Concussion Center.

Participants Athletes ages 12–23 presenting to a multi-disciplinary concussion center between 11/2017–10/2020. Athletes presenting >10 days post-injury and those sustaining >1 concussion during the study period were excluded.

Assessment of Risk Factors Demographics, medical/family medical history, injury characteristics, initial Post-Concussion Symptom Scale (PCSS) score.

Outcome Measures The primary outcome was the direct cost of concussion care episode, derived by matching visit and imaging dates with institution inflation-adjusted cost data.

Main Results In total, 710 athletes were included. Median age was 16.1 years (IQR=15.1–17.2; 66.5% male). Median initial PCSS was 26 (IQR=6–39). Sports with the highest prevalence of SRC were football (n=261, 36.8%), soccer (n=102, 14.4%) and basketball (n=97, 13.7%). Mean cost of an SRC care episode was $822 (SD=$1,233). Mean costs associated with softball-related concussion were highest (M=$2,372, SD=$4,707), followed by basketball (M=$1,012 SD=$1,863), lacrosse (M=$924, SD=$1,101), and American football (M=$814, SD=$993). A multivariable linear regression showed that higher initial PCSS (b=4.87, 95% CI=1.32–8.42, p=.007), number of prior concussions (b=118.79, 95% CI=42.71–194.88, p=.002), and having emergency department/urgent care visits (b=670.20, 95% CI=497.66–842.74) were significant predictors of greater cost.

Conclusions With a mean value of $822 per SRC, costs associated with this common injury total over $3 billion annually in the U.S. Greater costs were associated with higher symptom burden, prior concussion history, and emergency department/urgent care utilization. A nuanced understanding of cost-driving factors associated with SRC is a prerequisite to understanding cost-effectiveness of prevention/treatment.