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Abstract
BackgroundHybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI).MethodsWe conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted.ResultsThe hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability.ConclusionThe present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.
Highlights
In the last decade, two radiological procedures, that is, computed tomography (CT) and angiography are of increasing importance for the management of severe trauma [1, 2]
Outcomes analyzed were quality-adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER), which is the incremental cost associated with a new therapy needed to generate one additional Quality-adjusted life year (QALY), since this methodology for economic evaluation is commonly used in health system payers and health technology assessment organizations [9, 10]
Compared to the conventional group, the admission cost was significantly higher in the hybrid emergency room (ER) group
Summary
Two radiological procedures, that is, computed tomography (CT) and angiography are of increasing importance for the management of severe trauma [1, 2]. In 2011, we installed an angiography-CT in a trauma resuscitation room in order to obtain immediate access to both CT imaging and interventional procedures (Fig. 1). As this system enabled us to conduct all “examinations” and “treatments” without any patient transfer, we named it the “hybrid emergency room (ER).”. We previously reported that a novel trauma workflow using a hybrid ER decreased time to start bleeding control procedures and significantly reduced deaths from exsanguination [7]. Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI)
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