Tuesday, October 25, 2011: 2:00 PM
Columbus Hall C-F (Hyatt Regency Chicago)
(ESP) Applied Health Economics, Services, and Policy Research

Candidate for the Lee B. Lusted Student Prize Competition

M. Kit Delgado, MD1, David A. Spain, MD1, Kristan Staudenmayer, MD, MS1, Sharada Weir, Ph.D.2 and Jeremy D. Goldhaber-Fiebert, PhD3, (1)Stanford University School of Medicine, Stanford, CA, (2)University of Massachusetts Medical School, Shrewsbury, MA, (3)Stanford University, Stanford, CA

Purpose: Trauma centers (TC) reduce mortality by 25% for severely injured patients but cost significantly more than non-trauma centers (NTC). The CDC’s 2009 prehospital emergency medical services (EMS) guidelines seek to reduce undertriage of these patients to NTC to <5% and reduce overtriage of minor injury patients to TC to <25%. We assessed the cost-effectiveness of improving prehospital trauma triage in U.S. regions with <1 hour EMS access to TCs (84% of the population). 

Method: We developed a decision-analytic Markov model to evaluate improvements in prehospital trauma triage given a baseline undertriage rate of major injury patients to NTC of 20% and overtriage rate of minor trauma patients to TC of 50%. The model follows patients from injury through prehospital care, hospitalization, first year post-discharge, and the remainder of life. Patients are trauma victims with a mean age of 43 (range: 18-85) with Abbreviated Injury Scores (AIS) from 1-6. Cost and outcomes data were derived from the National Study on the Costs and Outcomes of Trauma for patients with moderate to severe injury (AIS 3-6), National Trauma Data Bank, and published literature for patients with minor injury (AIS 1-2).  Outcomes included costs (2009$), quality adjusted life-years (QALY), and incremental cost-effectiveness ratios.

Result: Reducing undertriage rates from 20% to 5% would yield 3.9 QALYs gained per 100 patients transported by EMS.  Reducing overtriage rates from 50% to 25% would save $108,000 per 100 patients transported.  Reducing both undertriage to 5% and overtriage to 25% would be cost-effective at $13,300/QALY gained and yield 3.9 QALYS per 100 patients.  One could spend $196,000 per 100 patients transported to reduce undertriage to 5% and overtriage to 45% and still achieve an incremental cost-effectiveness ratio below $50,000/QALY.  Results were somewhat sensitive to scenarios in which severely injured patients benefited less than expected from treatment at a TC relative to at a NTC or the cost difference of treating patients with minor injures at TCs and NTCs were smaller than expected.

Conclusion: Reducing prehospital undertriage of trauma patients is cost-effective and reducing overtriage of minor injury patients is cost-saving provided patients with minor injuries do not suffer worse outcomes from treatment at NTCs. With approximately 4.5 million annual EMS trauma transports, reducing overtriage by 25% could save up to $4.8 billion/year.