title: Cost-utility analysis of emergency department thoracotomy for trauma victims.
abstract: BACKGROUND
  Our objective was to assess the cost-effectiveness of emergency department thoracotomy (EDT) performed on both penetrating and blunt trauma victims, using both published survival and outcome data and previously unaccounted for data on the cost of occupational exposure.
  
  
  METHODS
  Cost-utility analysis was performed using decision-analytic models constructed for both penetrating and blunt trauma scenarios. Survival and impairment data, the rates and costs of occupational exposure, and the utilities of neurologic impairment and provider seroconversion were all based on published literature. Costs of EDT were estimated using the National Inpatient Sample (NIS) from the Health Care Utilization Project database. One-way sensitivity analyses on input parameters and probabilistic sensitivity analyses using Monte Carlo simulations were performed.
  
  
  RESULTS
  The incremental cost-effectiveness ratio of EDT for penetrating trauma was $16,125 per quality-adjusted life year (QALY), and less than $50,000 per QALY with a 93.4% probability. The incremental cost-effectiveness ratio for blunt trauma was $163,136 per QALY, and less than $50,000 per QALY with a 37% probability. Neither model was sensitive to provider exposure. The penetrating model was insensitive to the probability of neurologically intact survival, the utility adjustment, procedure costs, and long-term care. The blunt model was sensitive to the probabilities of survival and of neurologic impairment.
  
  
  CONCLUSIONS
  EDT is cost-effective for penetrating trauma, and not cost-effective for blunt trauma given current rates of survival and impairment. Occupational exposure does not significantly impact the cost-effectiveness of the procedure.
authors.affiliation: Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine 35294-0022, USA.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Brown
authors.forename: Marcus
authors.initials: M
authors.lastname: Romanello
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
mesh_terms: D017848:Blood-Borne Pathogens; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics*; D006282:Health Personnel; D006801:Humans; D016273:Occupational Exposure; D015996:Survival Rate; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*