Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Abstract

Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

Hybrid trauma service: on the leading edge of damage control

“…A cost-effectiveness study regarding the implementation of hybrid rooms was conducted in Japanese hospitals, estimating a benefit of 1.03 quality-adjusted life years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$35,552 per QALY. The analysis estimated that the implementation of an hybrid room has a probability of 79.3% of being cost-effective 19 , 20 .…”

“…Un estudio desarrollado en hospitales japoneses evaluó la costó-efectividad de una sala hibrida reportando que esta estrategia puede generar una ganancia de 1.03 años de vida ajustado QALY (quality-adjusted life year) y una relación de costo-efectividad incremental ICER (incremental cost-effectiveness ratio) de $35.552 dólares por QALY. Se estimo que la implementación de la sala hibrida tendría una probabilidad de ser costo-efectivo del 79.3% 19 , 20 .…”

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

“…The studies, listed in our references, that relate specifically to polytrauma patients with TBI [ 12 , 13 , 14 , 18 , 32 , 74 , 75 , 85 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ] are mainly written by acute care surgeons with respect to neurosurgeons and anesthesiologists ( Table 1 ). In this regard, a multidisciplinary approach (involving doctors with different specialties) is desirable in the future in order to improve patient outcomes in this difficult setting.…”

“…A higher survival benefit has been observed particularly in patients with higher ISS or with active bleeding [ 92 ]. The use of HERS has also been shown to be cost-effective [ 93 ].…”

The Longer The Decision-TAE Time, The Higher The Risk of Mortality: A Retrospective Study Of Trans-Arterial Embolization In Pelvic Fracture

“…These results might indicate that faster CT scanning can reduce the decision-TAE time, and therefore, the development of faster imaging strategies is essential. Recently, there have been reports on the effectiveness of hybrid emergency room systems 22,23 , hybrid operation rooms 24 , and mobile angiography systems 25 for trauma patients. These systems consist of an angiography-computed tomography (CT) machine in a trauma resuscitation room and have the potential to provide new evidence in this eld.…”