Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Jan 7;16(1):2.
doi: 10.1186/s13017-020-00344-x.

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

Takahiro Kinoshita  1   2 , Kensuke Moriwaki  3 , Nao Hanaki  4 , Tetsuhisa Kitamura  5 , Kazuma Yamakawa  6 , Takashi Fukuda  7 , Myriam G M Hunink  8   9   10 , Satoshi Fujimi  6
Affiliations
Comparative Study

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

Takahiro Kinoshita et al. World J Emerg Surg. .

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.

Keywords: HERS; ICER; Markov model; QALY; Utility.

PubMed Disclaimer

Conflict of interest statement

TKinoshita received lecture fees and travel expenses from Canon Medical Systems for lectures given at national and international conferences. TKinoshita was also supported by a Fulbright Japan Graduate Study Program during the conduct of this research. For the remaining authors, no conflicts were declared.

Figures

Fig. 1
Fig. 1
Picture of the angiography-CT equipment installed in the hybrid ER. CT scanning, REBOA, emergency surgery, and endovascular treatments are performed in this room without patient transfer. CT, computed tomography; ER, emergency room; REBOA, resuscitative endovascular balloon occlusion of the aorta
Fig. 2
Fig. 2
Model structure. Initial admission costs were included in the short-term decision tree and follow-up costs were included in the long-term Markov model. Capital investment costs were added on the admission costs only to the hybrid ER system. Twenty-eight-day mortality was used for the transition probability in the decision tree. Extrapolated 1- to 3-year mortality rates after trauma and Japanese life table were used for the transition probability in the Markov model. QALYs were calculated using utility of intensive care patients in the decision tree and long-term utility after severe trauma in the Markov model. The only differences between two strategies were initial transition probability, initial admission costs, and capital investment costs. ER, emergency room; QALY, quality-adjusted life year
Fig. 3
Fig. 3
Deterministic sensitivity analysis. The tornado diagram showing the results of worst and best case scenario based on the plausible ranges of the parameters. The vertical solid line represents the willingness-to-pay threshold ($47,619), and the vertical dotted line represents the ICER from the base-case scenario ($32,522). Horizontal bars represent the estimated ICERs based on the plausible range of the parameters. ER, emergency room; ICER, incremental cost-effectiveness ratio
Fig. 4
Fig. 4
Probabilistic sensitivity analysis. a Cost-effectiveness scatterplot. Each plot shows a result of one simulation. Plots located in the first quadrants suggest that both cost and effect are higher in the hybrid ER system (trade-off) and plots located in the second quadrants suggest that cost is higher but effect is lower in the hybrid ER system (inferior). Plots reside under the dotted line of willingness-to-pay threshold suggest that the results of the simulations are cost-effective. b Cost-effectiveness acceptability curve. The line with square markers shows the probability that the conventional ER is cost-effective and the line with triangle markers shows the probability that the hybrid ER is cost-effective at each willingness-to-pay threshold. ER, emergency room
See this image and copyright information in PMC

References

    1. Huber-Wagner S, Lefering R, Qvick LM, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–1461. doi: 10.1016/S0140-6736(09)60232-4. - DOI - PubMed
    1. Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24. doi: 10.1186/s13017-020-00302-7. - DOI - PMC - PubMed
    1. Wurmb TE, Frühwald P, Hopfner W, et al. Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. J Trauma. 2009;66:658–665. doi: 10.1097/TA.0b013e31817de3f4. - DOI - PubMed
    1. Saltzherr TP, Bakker FC, Beenen LF, et al. Randomized clinical trial comparing the effect of computed tomography in the trauma room versus the radiology department on injury outcomes. Br J Surg. 2012;99(Suppl 1):105–113. doi: 10.1002/bjs.7705. - DOI - PubMed
    1. Matsushima K, Piccinini A, Schellenberg M, et al. Effect of door-to-angioembolization time on mortality in pelvic fracture: Every hour of delay counts. J Trauma Acute Care Surg. 2018;84:685–692. doi: 10.1097/TA.0000000000001803. - DOI - PubMed

Publication types

LinkOut - more resources