title: Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.
abstract: Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.
authors.affiliation: Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email:.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.affiliation: Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email:.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.affiliation: Centre for Population Health Research, Curtin University, Bentley, WA 6102, Australia. Email.
authors.forename: Delia
authors.initials: D
authors.lastname: Hendrie
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic. 3004, Australia. Email.
authors.forename: Belinda
authors.initials: B
authors.lastname: Gabbe
authors.affiliation: Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email:.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Byrne
authors.affiliation: Injury Division, The George Institute for Global Health, The University of Sydney, Sydney Medical School, 321 Kent Street, Sydney, NSW 2000, Australia. Email.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000191:economics*; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy*