An economic evaluation of trauma care in a Canadian lead trauma hospital.

BACKGROUND The objective was to determine the average cost per quality-adjusted life year (QALY) gained of treating trauma victims at a tertiary trauma hospital and to determine the cost-effectiveness of trauma care at this center. The setting was a tertiary trauma center in the province of Ontario, Canada. The study population consisted of consecutive trauma admissions with ISS > 12 from April, 1994 to April, 1996. The study was of a retrospective cohort design with a cross-sectional survey. METHODS The hospital perspective was taken. Costs were determined from a retrospective cohort using a hospital-based case-costing system. Utility estimates for calculation of QALYs gained were obtained using a cross-sectional survey design. Cost-effectiveness was determined by estimating the incremental cost/QALY attributable to treatment at the trauma center. Sensitivity analysis was employed to vary assumptions about the proportion of costs and increased survival. RESULTS 484 patients with a median age of 39 years and a median ISS of 22 were studied. The average cost per QALY was $1,721, with a maximum value of $3,861. The increase in cost per QALY gained for treatment in a tertiary care center as opposed to a nontrauma center was $4,303, assuming a 20% increase in survival and assuming that the existence of the center increased the cost of care by 50%. The incremental cost/QALY ranged from $191 to $15,492 in the sensitivity analysis varying assumptions about the increased proportion of costs and survival attributable to care at the tertiary trauma center. CONCLUSIONS This is the first economic evaluation of tertiary trauma care which includes both costs as opposed to charges as well as estimates of the QALYs gained. The results suggest that tertiary trauma care is cost-effective and less costly than treatment programs for other disease conditions when the quality-adjusted life years gained are included in the evaluation.