title: Quantifying the healthcare costs of treating severely bleeding major trauma patients: a national study for England.
abstract: BACKGROUND
  Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40% of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions.
  
  
  METHODS
  In collaboration with the Trauma Audit Research Network (TARN) detailed patient-level data on in-hospital resource use, extended care at hospital discharge, and readmissions up to 12 months post-injury were collected on 441 consecutive adult major trauma patients with severe bleeding presenting at 22 hospitals (21 in England and one in Wales). Resource use data were costed using national unit costs and mean costs estimated for the cohort and for clinically relevant subgroups. Using nationally available data on trauma presentations in England, patient-level cost estimates were up-scaled to a national level.
  
  
  RESULTS
  The mean (95% confidence interval) total cost of initial hospital inpatient care was £19,770 (£18,177 to £21,364) per patient, of which 62% was attributable to ventilation, intensive care, and ward stays, 16% to surgery, and 12% to blood component transfusion. Nursing home and rehabilitation unit care and re-admissions to hospital increased the cost to £20,591 (£18,924 to £22,257). Costs were significantly higher for more severely injured trauma patients (Injury Severity Score ≥15) and those with blunt injuries. Cost estimates for England were £148,300,000, with over a third of this cost attributable to patients aged 65 years and over.
  
  
  CONCLUSIONS
  Severely bleeding major trauma patients are a high cost subgroup of all major trauma patients, and the cost burden is projected to rise further as a consequence of an aging population and as evidence continues to emerge on the benefits of early and simultaneous administration of blood products in pre-specified ratios. The findings from this study provide a previously unreported baseline from which the potential impact of changes to service provision and/or treatment practice can begin to be evaluated. Further studies are still required to determine the full costs of post-discharge care requirements, which are also likely to be substantial.
authors.affiliation: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. helen.campbell@dph.ox.ac.uk.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Campbell
authors.affiliation: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. elizabeth.stokes@dph.ox.ac.uk.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stokes
authors.affiliation: Eli Lilly and Company Limited, Lilly House, Priestley Road, Basingstoke, Hampshire, RG24 9NL, UK. bargo_danielle_nicole@lilly.com.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Bargo
authors.affiliation: Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, OX3 7LE, UK. Nicola.Curry@ouh.nhs.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Curry
authors.affiliation: Trauma Audit and Research Network, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK. fiona.lecky@manchester.ac.uk.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.affiliation: Trauma Audit and Research Network, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK. Antoinette.Edwards@manchester.ac.uk.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Trauma Audit and Research Network, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK. Maralyn.Woodford@manchester.ac.uk.
authors.forename: Maralyn
authors.initials: M
authors.lastname: Woodford
authors.affiliation: NHS Blood and Transplant Clinical Trials Unit, Fox Den Road, Stoke Gifford, Bristol, BS34 8RR, UK. Frances.Seeney@nhsbt.nhs.uk.
authors.forename: Frances
authors.initials: F
authors.lastname: Seeney
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, The Blizard Building, 4 Newark Street, London, E1 2AT, UK. s.eaglestone@qmul.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaglestone
authors.affiliation: Blizard Institute, Barts and The London School of Medicine and Dentistry, The Blizard Building, 4 Newark Street, London, E1 2AT, UK. k.brohi@qmul.ac.uk.
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.affiliation: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. alastair.gray@dph.ox.ac.uk.
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Gray
authors.affiliation: NHS Blood and Transplant and Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9BQ, UK. simon.stanworth@nhsbt.nhs.uk.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Stanworth
mesh_terms: D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion / Q000191:economics; D003422:Critical Care / Q000191:economics; D004632:Emergency Medical Services / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics; D004739:England / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D012121:Respiration, Artificial / Q000191:economics; D014947:Wounds and Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy