title: Pilot study on the comprehensive economic costs of major trauma: Consequential costs are well in excess of medical costs.
abstract: BACKGROUND
  Trauma care is expensive. However, reliable data on the exact lifelong costs incurred by a major trauma patient are lacking. Discussion usually focuses on direct medical costs--underestimating consequential costs resulting from absence from work and permanent disability.
  
  
  METHODS
  Direct medical costs and consequential costs of 63 major trauma survivors (ISS >13) at a Swiss trauma center from 1995 to 1996 were assessed 5 years posttrauma. The following cost evaluation methods were used: correction cost method (direct cost of restoring an original state), human capital method (indirect cost of lost productivity), contingent valuation method (human cost as the lost quality of life), and macroeconomic estimates.
  
  
  RESULTS
  Mean ISS (Injury Severity Score) was 26.8 +/- 9.5 (mean +/- SD). In all, 22 patients (35%) were disabled, causing discounted average lifelong total costs of USD 1,293,800, compared with 41 patients (65%) who recovered without any disabilities with incurred costs of USD 147,200 (average of both groups USD 547,800). Two thirds of these costs were attributable to a loss of production whereas only one third was a result of the cost of correction. Primary hospital treatment (USD 27,800 +/- 37,800) was only a minor fraction of the total cost--less than the estimated cost of police and the judiciary. Loss of quality of life led to considerable intangible human costs similar to real costs.
  
  
  CONCLUSIONS
  Trauma costs are commonly underestimated. Direct medical costs make up only a small part of the total costs. Consequential costs, such as lost productivity, are well in excess of the usual medical costs. Mere cost averages give a false estimate of the costs incurred by patients with/without disabilities.
authors.affiliation: Inselspital Notfallzentrum, University of Berne, Switzerland. jhaeusler@gmx.net
authors.forename: Jean-Marc C
authors.initials: JM
authors.lastname: Haeusler
authors.forename: Benno
authors.initials: B
authors.lastname: Tobler
authors.forename: Beat
authors.initials: B
authors.lastname: Arnet
authors.forename: Juerg
authors.initials: J
authors.lastname: Huesler
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
mesh_terms: D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000191:economics*; D015999:Multivariate Analysis; D010865:Pilot Projects; D011788:Quality of Life; D013557:Switzerland; D014193:Trauma Centers / Q000191:economics; D014194:Traumatology / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy