Quantifying the healthcare costs of treating severely bleeding major trauma patients: a national study for England View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-12-01

AUTHORS

Helen E. Campbell, Elizabeth A. Stokes, Danielle N. Bargo, Nicola Curry, Fiona E. Lecky, Antoinette Edwards, Maralyn Woodford, Frances Seeney, Simon Eaglestone, Karim Brohi, Alastair M. Gray, Simon J. Stanworth

ABSTRACT

INTRODUCTION: Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40% of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions. METHODS: In collaboration with the Trauma Audit Research Network (TARN) detailed patient-level data on in-hospital resource use, extended care at hospital discharge, and readmissions up to 12 months post-injury were collected on 441 consecutive adult major trauma patients with severe bleeding presenting at 22 hospitals (21 in England and one in Wales). Resource use data were costed using national unit costs and mean costs estimated for the cohort and for clinically relevant subgroups. Using nationally available data on trauma presentations in England, patient-level cost estimates were up-scaled to a national level. RESULTS: The mean (95% confidence interval) total cost of initial hospital inpatient care was £19,770 (£18,177 to £21,364) per patient, of which 62% was attributable to ventilation, intensive care, and ward stays, 16% to surgery, and 12% to blood component transfusion. Nursing home and rehabilitation unit care and re-admissions to hospital increased the cost to £20,591 (£18,924 to £22,257). Costs were significantly higher for more severely injured trauma patients (Injury Severity Score ≥15) and those with blunt injuries. Cost estimates for England were £148,300,000, with over a third of this cost attributable to patients aged 65 years and over. CONCLUSIONS: Severely bleeding major trauma patients are a high cost subgroup of all major trauma patients, and the cost burden is projected to rise further as a consequence of an aging population and as evidence continues to emerge on the benefits of early and simultaneous administration of blood products in pre-specified ratios. The findings from this study provide a previously unreported baseline from which the potential impact of changes to service provision and/or treatment practice can begin to be evaluated. Further studies are still required to determine the full costs of post-discharge care requirements, which are also likely to be substantial. More... »

PAGES

276

Journal

TITLE

Critical Care

ISSUE

1

VOLUME

19

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13054-015-0987-5

DOI

http://dx.doi.org/10.1186/s13054-015-0987-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1039960447

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26148506


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32 schema:description INTRODUCTION: Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40% of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions. METHODS: In collaboration with the Trauma Audit Research Network (TARN) detailed patient-level data on in-hospital resource use, extended care at hospital discharge, and readmissions up to 12 months post-injury were collected on 441 consecutive adult major trauma patients with severe bleeding presenting at 22 hospitals (21 in England and one in Wales). Resource use data were costed using national unit costs and mean costs estimated for the cohort and for clinically relevant subgroups. Using nationally available data on trauma presentations in England, patient-level cost estimates were up-scaled to a national level. RESULTS: The mean (95% confidence interval) total cost of initial hospital inpatient care was £19,770 (£18,177 to £21,364) per patient, of which 62% was attributable to ventilation, intensive care, and ward stays, 16% to surgery, and 12% to blood component transfusion. Nursing home and rehabilitation unit care and re-admissions to hospital increased the cost to £20,591 (£18,924 to £22,257). Costs were significantly higher for more severely injured trauma patients (Injury Severity Score ≥15) and those with blunt injuries. Cost estimates for England were £148,300,000, with over a third of this cost attributable to patients aged 65 years and over. CONCLUSIONS: Severely bleeding major trauma patients are a high cost subgroup of all major trauma patients, and the cost burden is projected to rise further as a consequence of an aging population and as evidence continues to emerge on the benefits of early and simultaneous administration of blood products in pre-specified ratios. The findings from this study provide a previously unreported baseline from which the potential impact of changes to service provision and/or treatment practice can begin to be evaluated. Further studies are still required to determine the full costs of post-discharge care requirements, which are also likely to be substantial.
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39 schema:keywords Audit Research Network (TARN) detailed patient-level data
40 England
41 Further studies
42 Network (TARN) detailed patient-level data
43 Research Network (TARN) detailed patient-level data
44 Trauma Audit Research Network (TARN) detailed patient-level data
45 administration
46 adult major trauma patients
47 available data
48 baseline
49 benefits
50 bleeding
51 blood component transfusion
52 blood products
53 blunt injury
54 burden
55 care
56 care requirements
57 changes
58 cohort
59 collaboration
60 component transfusion
61 consecutive adult major trauma patients
62 consequences
63 cost
64 cost burden
65 cost estimates
66 cost reduction strategies
67 cost subgroup
68 data
69 death
70 detailed patient-level data
71 discharge
72 estimates
73 evidence
74 extended care
75 findings
76 full cost
77 health policy
78 healthcare costs
79 healthcare resource use
80 high-cost subgroups
81 home
82 hospital
83 hospital discharge
84 hospital inpatient care
85 hospital resource use
86 impact
87 initial hospital inpatient care
88 injury
89 inpatient care
90 intensive care
91 intervention
92 knowledge
93 knowledge of costs
94 levels
95 major trauma patients
96 major trauma population
97 mean total cost
98 months
99 national level
100 national study
101 national unit costs
102 nursing homes
103 patient-level cost estimates
104 patient-level data
105 patients
106 policy
107 population
108 post-discharge care requirements
109 potential impact
110 practice
111 pre-specified ratios
112 presentation
113 products
114 proportion
115 provision
116 ratio
117 readmission
118 reduction strategies
119 rehabilitation unit care
120 relevant subgroups
121 requirements
122 resource use
123 resource use data
124 service provision
125 severe bleeding
126 simultaneous administration
127 small proportion
128 stay
129 strategies
130 study
131 subgroups
132 surgery
133 third
134 total cost
135 transfusion
136 trauma deaths
137 trauma patients
138 trauma population
139 trauma presentations
140 treatment practices
141 unit care
142 unit cost
143 unreported baseline
144 use
145 use data
146 ventilation
147 ward stay
148 years
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