Sat., 10/6/12 General Interest, PAPER #105, 2:24 pm OTA-2012
The Cost Effectiveness and Utility of Trauma Center Care Following Major Lower Extremity Trauma
Herman S. Johal, MD, MPH1; Ellen J. MacKenzie, PhD2;
1University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada;
2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Purpose: This study was conducted to estimate the 1-year and lifetime treatment costs, incremental cost effectiveness, and incremental cost utility of treatment at a Level I trauma center compared with that of treatment at a non-trauma center for patients with major lower extremity injuries.
Methods: Secondary analysis was conducted on a US dataset from the National Study on Costs and Outcomes of Trauma (NSCOT), a multi-institutional, prospective study that examined the costs and outcomes of care received by 5191 adult trauma patients. NSCOT data were collected from 18 Level I trauma centers and 51 non-trauma centers located in 14 US states. Patients were recruited during an 18-month period (July 1, 2001 to November 30, 2002). Patients were taken from those eligible for the NSCOT parent study. This analysis included 1389 patients between 18 and 84 years of age, presenting to 1 of the 69 NSCOT institutions and having at least one lower extremity injury with an Abbreviated Injury Scale (AIS) score ≥3. Cost data were derived from Medicare and Medicaid Services, hospital bills, and patient interviews. Cost-effectiveness was estimated as the ratio of the difference in costs over the difference in life years gained. Cost utility was measured as the cost per quality-adjusted life year (QALY) gained, using outcome data from the SF-6D. All analysis was performed with the use of data weighted back to the original population meeting inclusion criteria, which when applied to the sample of 1389 patients yielded a study population of 4619 patients. Inverse probability of treatment weighting was also used to adjust for observable differences in patients and case mix variation between trauma centers and non-trauma centers. Ratios of incremental costs and incremental effectiveness were derived for all patients, and separately for subgroups defined by high versus low energy and age. Cost-effectiveness acceptability curves (CEACs) were used to quantify and represent estimate uncertainty.
Results: The added cost for treatment in a trauma center compared to a non-trauma center for patients with major lower extremity injuries was $1,901,287 per life saved, $105,455 per life-year gained, and $63,538 per QALY gained. Cost-effectiveness and cost utility were more favorable for lower extremity injuries resulting from high-energy versus low-energy mechanisms, and for younger versus older patients.
Conclusion: Regionalization of orthopaedic trauma care is effective and also cost effective for younger patients and those who sustain high-energy lower limb trauma.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.