Abstract
BackgroundIn order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries.MethodsA systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities.ResultsA total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age.ConclusionThe acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the treatment costs. Targeted research into the costs of trauma care is required to facilitate informed health service planning.
Highlights
In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential
The search strategy yielded 443 studies of which 27 were included in the final analysis (Figure 1). Four of these articles were published in non-English languages and were translated into English
Sixteen (61.5%) studies were conducted in USA [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36], three (11.5%) in the UK [37,38,39] and Germany [40,41,42] and two (7.7%) in Australia [43], and one (3.7%) in Switzerland
Summary
In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Injury impacts society significantly on a physical, psychological and economical level [2], costing an estimated US$518 billion globally [3]. The aim of a trauma system is to facilitate treatment of severely injured patients at a hospital with the appropriate resources. This approach has been demonstrated to significantly reduce trauma patient morbidity in Australia [5,6,7] and internationally [5,7,8,9]
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