Analysis Shows That Trauma Center Care Is Cost Effective, Saves QALYs

PITTSBURGH — Treatment at trauma centers was associated with 70 additional life-years per 100 patients, compared with care at nontrauma centers in a large, multistate study.

Although care at a trauma center was found to be more expensive than care at a nontrauma hospital, trauma center costs were well within widely accepted benchmarks used to judge cost-effectiveness, Ellen MacKenzie, Ph.D., said at the annual meeting of the American Association for the Surgery of Trauma.

The cohort of 5,043 severely injured adult trauma patients received care in 69 hospitals in 14 states. In all, 1,085 patients died. All patients who were discharged were contacted by phone at 3 and 12 months to determine their use of health services and assess their functional status. Medical records, claims data from the Centers for Medicare and Medicaid Services, hospital bills, and patient interviews were used to calculate costs.

The researchers estimated cost-effectiveness using three standard methods: cost per life saved, cost per life-year gained, and cost per quality-adjusted life-year (QALY) gained. Using data from the National Study for Cost and Outcomes in Trauma database, they included patients who died or who sustained an injury with an Abbreviated Injury Score of at least 3.

To estimate incremental life years gained, the researchers assumed that a survivor benefit from trauma center care does not extend beyond 1 year post injury. They also discounted future life-years by the standard value of 3%. This analysis found 70 additional life-years per 100 patients in trauma versus nontrauma centers.

QALYs were calculated using adjusted values on the Short Form-16 at 3 and 12 months, together with assumptions about how function declines with age. To estimate costs, the researchers derived estimates of 1-year treatment costs using previous data, then projected lifetime costs, making some assumptions about life expectancy and ongoing medical expenditures for survivors.

The added cost of treatment in a trauma center versus a non–trauma center was found to be $36,319 per life-year gained ($790,931 per life saved) and $36,961 per QALY gained—well within the cost-effectiveness ratios of $50,000 to $100,000 per life-year gain deemed acceptable in the literature. The higher price tag associated with treatment at a trauma center is attributable largely to costs incurred during initial hospitalization.

The difference between the two types of facilities in per-lifetime patient costs was estimated to be $20,000, said Dr. MacKenzie, chair of the department of health policy and management at the Johns Hopkins University's Bloomberg School of Public Health.

The study “provides data that is likely to be critical in our efforts to persuade legislators and the public to invest in trauma systems infrastructure,” said the invited discussant for the paper, Dr. Robert C. Mackersie, professor of surgery and director of trauma services at San Francisco General Hospital.

Disclosures: Dr. MacKenzie reported that she has no relevant financial relationships.

PITTSBURGH — Treatment at trauma centers was associated with 70 additional life-years per 100 patients, compared with care at nontrauma centers in a large, multistate study.

Although care at a trauma center was found to be more expensive than care at a nontrauma hospital, trauma center costs were well within widely accepted benchmarks used to judge cost-effectiveness, Ellen MacKenzie, Ph.D., said at the annual meeting of the American Association for the Surgery of Trauma.

The cohort of 5,043 severely injured adult trauma patients received care in 69 hospitals in 14 states. In all, 1,085 patients died. All patients who were discharged were contacted by phone at 3 and 12 months to determine their use of health services and assess their functional status. Medical records, claims data from the Centers for Medicare and Medicaid Services, hospital bills, and patient interviews were used to calculate costs.

The researchers estimated cost-effectiveness using three standard methods: cost per life saved, cost per life-year gained, and cost per quality-adjusted life-year (QALY) gained. Using data from the National Study for Cost and Outcomes in Trauma database, they included patients who died or who sustained an injury with an Abbreviated Injury Score of at least 3.

To estimate incremental life years gained, the researchers assumed that a survivor benefit from trauma center care does not extend beyond 1 year post injury. They also discounted future life-years by the standard value of 3%. This analysis found 70 additional life-years per 100 patients in trauma versus nontrauma centers.

QALYs were calculated using adjusted values on the Short Form-16 at 3 and 12 months, together with assumptions about how function declines with age. To estimate costs, the researchers derived estimates of 1-year treatment costs using previous data, then projected lifetime costs, making some assumptions about life expectancy and ongoing medical expenditures for survivors.

The added cost of treatment in a trauma center versus a non–trauma center was found to be $36,319 per life-year gained ($790,931 per life saved) and $36,961 per QALY gained—well within the cost-effectiveness ratios of $50,000 to $100,000 per life-year gain deemed acceptable in the literature. The higher price tag associated with treatment at a trauma center is attributable largely to costs incurred during initial hospitalization.

The difference between the two types of facilities in per-lifetime patient costs was estimated to be $20,000, said Dr. MacKenzie, chair of the department of health policy and management at the Johns Hopkins University's Bloomberg School of Public Health.

The study “provides data that is likely to be critical in our efforts to persuade legislators and the public to invest in trauma systems infrastructure,” said the invited discussant for the paper, Dr. Robert C. Mackersie, professor of surgery and director of trauma services at San Francisco General Hospital.

Disclosures: Dr. MacKenzie reported that she has no relevant financial relationships.

PITTSBURGH — Treatment at trauma centers was associated with 70 additional life-years per 100 patients, compared with care at nontrauma centers in a large, multistate study.

Although care at a trauma center was found to be more expensive than care at a nontrauma hospital, trauma center costs were well within widely accepted benchmarks used to judge cost-effectiveness, Ellen MacKenzie, Ph.D., said at the annual meeting of the American Association for the Surgery of Trauma.

The cohort of 5,043 severely injured adult trauma patients received care in 69 hospitals in 14 states. In all, 1,085 patients died. All patients who were discharged were contacted by phone at 3 and 12 months to determine their use of health services and assess their functional status. Medical records, claims data from the Centers for Medicare and Medicaid Services, hospital bills, and patient interviews were used to calculate costs.

The researchers estimated cost-effectiveness using three standard methods: cost per life saved, cost per life-year gained, and cost per quality-adjusted life-year (QALY) gained. Using data from the National Study for Cost and Outcomes in Trauma database, they included patients who died or who sustained an injury with an Abbreviated Injury Score of at least 3.

To estimate incremental life years gained, the researchers assumed that a survivor benefit from trauma center care does not extend beyond 1 year post injury. They also discounted future life-years by the standard value of 3%. This analysis found 70 additional life-years per 100 patients in trauma versus nontrauma centers.

QALYs were calculated using adjusted values on the Short Form-16 at 3 and 12 months, together with assumptions about how function declines with age. To estimate costs, the researchers derived estimates of 1-year treatment costs using previous data, then projected lifetime costs, making some assumptions about life expectancy and ongoing medical expenditures for survivors.

The added cost of treatment in a trauma center versus a non–trauma center was found to be $36,319 per life-year gained ($790,931 per life saved) and $36,961 per QALY gained—well within the cost-effectiveness ratios of $50,000 to $100,000 per life-year gain deemed acceptable in the literature. The higher price tag associated with treatment at a trauma center is attributable largely to costs incurred during initial hospitalization.

The difference between the two types of facilities in per-lifetime patient costs was estimated to be $20,000, said Dr. MacKenzie, chair of the department of health policy and management at the Johns Hopkins University's Bloomberg School of Public Health.

The study “provides data that is likely to be critical in our efforts to persuade legislators and the public to invest in trauma systems infrastructure,” said the invited discussant for the paper, Dr. Robert C. Mackersie, professor of surgery and director of trauma services at San Francisco General Hospital.

Disclosures: Dr. MacKenzie reported that she has no relevant financial relationships.