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.

A short decision time for transcatheter embolization can better associate mortality in patients with pelvic fracture: a retrospective study

“…Additionally, the transferred patients underwent TAE within a short duration, indicating that fast CT scanning can reduce decision-TAE time; hence, the development of fast imaging strategies is essential. Recent reports have suggested the effectiveness of hybrid emergency room systems (38,39), hybrid operation rooms (40), and mobile angiography systems (41) for treating patients with trauma. These systems consist of an angiography-CT machine in a trauma resuscitation room and have the potential to provide new evidence in this field.…”

Case Report and Minireview of the Literature on Blunt Azygos Injury

“…The fact that the diagnostic studies included as part of the initial ATLS ® trauma survey are not well equipped to diagnose such a fatal vascular injury 37) . In addition, recent studies showed the efficacy of evaluation using whole CT during resuscitation in the hybrid ER, for even trauma patients with unstable circulation, in order to detect sites of hemorrhaging and facilitate the immediate performance procedures to obtain hemostasis [38][39][40][41] . Accordingly, to increase the survival rate of patients with fatal vascular injuries, such as blunt azygos injury, the early recognition of the site of hemorrhaging using CT and the immediate execution of surgical hemostasis in an appropriate position for modern surgeons (less experienced in the management of severe trauma) may be required, even when initial fluid resuscitation fails and unstable circulation remains.…”