title: Cost-effectiveness of the Cardiac Component of the Focused Assessment of Sonography in Trauma Examination in Blunt Trauma.
abstract: BACKGROUND
  Blunt cardiac injury severe enough to require surgical intervention (sBCI) is an exceedingly rare event occurring in approximately 1 out of every 1600 trauma patients. While performing the cardiac component of the Focused Assessment of Sonography in Trauma (cFAST) exam is effective in penetrating trauma, it is unclear whether it is of value in blunt trauma given the low prevalence of sBCI, the imperfect test characteristics of the FAST exam, and the rate of incidental pericardial effusion.
  
  
  OBJECTIVE
  The objective was to determine through decision analysis whether performing the cFAST exam is cost-effective in the evaluation of hypotensive and normotensive blunt trauma patients.
  
  
  METHODS
  We created two decision analytic models using commercially available software (TreeAgePro2011) to evaluate the cost-effectiveness of the cFAST in hypotensive (systolic blood pressure <90 mm Hg) and normotensive blunt trauma patients. Clinical probabilities were obtained from published data. Costs were estimated from Medicare reimbursement and charge data. The willingness-to-pay threshold was $50,000/quality-adjusted life-years (QALYs). Sensitivity analyses were performed over plausible ranges using available literature.
  
  
  RESULTS
  In hypotensive patients, for the base case scenario of a 34-year-old with blunt trauma, the cFAST strategy had a cost of $42,882.70 and an effectiveness of 25.3597 QALYs, whereas the no cFAST strategy had a cost of $42,753.52 and an effectiveness of 25.3532 QALYs. The incremental cost-effectiveness ratio (ICER) was $19,918/QALY. For normotensive patients the cFAST strategy had a cost of $18,331.03 and an effectiveness of 23.2817 QALYs, whereas the no cFAST strategy had a cost of $18,207.58 and an effectiveness of 23.2814 QALYs. The ICER was $465,867/QALY. In the sensitivity analyses, age, probability of death from sBCI with prompt treatment, and probability of sBCI were the main drivers of variability in the model outcomes.
  
  
  CONCLUSIONS
  The cFAST for blunt trauma is cost-effective for hypotensive but not for normotensive patients. The ICER for hypotensive patients was more than 20 times higher than the ICER for normotensive patients. Our results suggest that performing the cFAST exam may not be an effective use of resources in normotensive blunt trauma patients.
authors: Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.|Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors: M Kennedy
authors: MK
authors: Hall
authors: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors: Talib
authors: T
authors: Omer
authors: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors: Chris L
authors: CL
authors: Moore
authors: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors: R Andrew
authors: RA
authors: Taylor
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D008017:Life Expectancy; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D019095:Point-of-Care Systems / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D014463:Ultrasonography; D014481:United States; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology