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Research article
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
Osaka General Medical Center
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at World Journal of Emergency Surgery.
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
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Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 09 Nov, 2020
Published
On 07 Jan, 2021
No community comments so far
Review #1 received
Received 24 Nov, 2020
Editorial decision: Accept
On 24 Nov, 2020
Reviewer #1 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 07 Nov, 2020
Submission checks complete
On 07 Nov, 2020
Editor invited
On 07 Nov, 2020
Version (no preprint)
Posted 31 Oct, 2020
Review #1 received
Received 31 Oct, 2020
Editorial decision: Major revision
On 31 Oct, 2020
Reviewer #2 agreed
On 29 Oct, 2020
Review #2 received
Received 29 Oct, 2020
Reviewers invited
Invitations sent on 20 Oct, 2020
Reviewer #1 agreed
On 20 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 19 Oct, 2020
Editor invited
On 19 Oct, 2020
First submitted
On 18 Oct, 2020
This version was not preprinted
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
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This preprint is under consideration at World Journal of Emergency Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
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
Osaka General Medical Center
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 09 Nov, 2020
Published
On 07 Jan, 2021
No community comments so far
Review #1 received
Received 24 Nov, 2020
Editorial decision: Accept
On 24 Nov, 2020
Reviewer #1 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 07 Nov, 2020
Submission checks complete
On 07 Nov, 2020
Editor invited
On 07 Nov, 2020
Version (no preprint)
Posted 31 Oct, 2020
Review #1 received
Received 31 Oct, 2020
Editorial decision: Major revision
On 31 Oct, 2020
Reviewer #2 agreed
On 29 Oct, 2020
Review #2 received
Received 29 Oct, 2020
Reviewers invited
Invitations sent on 20 Oct, 2020
Reviewer #1 agreed
On 20 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 19 Oct, 2020
Editor invited
On 19 Oct, 2020
First submitted
On 18 Oct, 2020
This version was not preprinted
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at World Journal of Emergency Surgery.
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.
Figure 1
Figure 2
Figure 3
Figure 4