Trauma Center Care Costs Warranted, Study Suggests

Trauma center treatment cost more when compared with non-trauma centers, but the overall benefits in terms of lives saved and quality of life-years gained, represents a more cost-effective way of treating patients with major trauma.

The Johns Hopkins Bloomberg School of Public Health study found that the added cost of treatment at a trauma center versus a non-trauma center is $36,319 for every life-year gained or $790,931 per life saved. This is despite the fact that initial care in trauma centers is 71% higher than in non-trauma centers, say the researchers in The Journal of Trauma Injury, Infection and Critical Care.

Sources for the study include:

• Data from 5,043 major trauma patients enrolled in the National Study on Costs and Outcomes of Trauma, a prospective study of severely injured adult patients cared for in 69 hospitals (18 trauma centers and 51 non-trauma centers) in 14 states
• Claims data from CMS
• UB92 hospital bills
• Patient interviews

In addition to care received in the hospital, costs linked with:

• Hospital transport,
• Treatment at transferring hospital,
• Rehospitalizations for acute care,
• Inpatient rehabilitation,
• Stays in long-term facilities,
• Outpatient care,
• Informal care from friends or family members

Lifetime costs were modeled using age-specific estimates of per capita personal health expenditures for the general U.S. population, along limited data on the impact of certain injures on lifetime healthcare costs.

While the value of a year of life is the subject of considerable debate, the researchers say that the costs per life-year saved at a trauma center are "well within an acceptable range of other cost-effective, life-saving interventions reported in the literature."

Cost-effectiveness was estimated as the ratio of the difference in costs, treatment at a trauma center vs. non-trauma center, divided by the difference in life years gained, plus lives saved, the researchers say.

Also, while trauma center care was cost-effective for all patients, it was particularly valuable for individuals with severe injuries and for patients younger than 55 years. The costs per life-year gained were higher for patients with less severe injuries.

"Each year in the United States, more than two million people are hospitalized for treatment of a traumatic injury. Because injuries often happen in children and young adults, the years of potential life lost are significant," says Richard Hunt, MD, director of the Division of Injury Response in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention.

"We know that getting the most critically injured patients the right care, at the right place, at the right time can help save lives," he says.

Overall, the results underscore the importance of designing trauma systems that assures that patients are taken to the level of care appropriate to their needs, the researchers concluded. Taking the less severely injured to a lower level of trauma care will yield "lower costs and increased efficiency in the system."