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Reducing the Burden of Injury: Advancing Prevention and Treatment
Cost-Effectiveness of Trauma Care Systems
The cost-effectiveness of trauma care systems only recently has begun to be explored. Miller and Levy (1995) were among the first to study the cost-effectiveness of these systems. Using 217,000 randomly sampled workers' compensation claims from 17 states (1979–1988), these investigators examined the cost-effectiveness in terms of lowered direct medical costs and increased worker productivity. They determined that, in states with trauma care systems, hospital and nonhospital medical care payments for acute care and rehabilitation for four types of injuries were, on average, 5–18 percent less costly per episode than those in states without such systems. Likewise, productivity (in terms of days at work) was enhanced. Extrapolating their figures to the nation as a whole, the authors estimated that if trauma systems were implemented nationwide, savings of $10.3 billion (in 1988 dollars) would be realized in increased productivity and lower medical payments. The largest portion of savings would be from productivity gains ($7.1 billion). The authors were careful to point out the limitations of their data set, namely, that results may not generalize to nonworker populations and to certain types of injury (e.g., head injuries). With enhanced productivity accounting for such a large proportion of savings, it may be difficult to establish the cost-effectiveness of trauma systems for older patients. The authors also acknowledged that their analysis fails to include potential indirect effects of trauma care systems on cost.
Targeted studies have addressed the cost-effectiveness of select elements of prehospital and rehabilitation care. For example, a recently published analysis of 13 previously published data sets found that helicopter medical transport is cost-effective in terms of cost per year of life saved, and is more cost-effective than other emergency medical interventions (Gearhart et al., 1997). Helicopter and ground transport directly from the scene of injury to a trauma center led to significantly shorter lengths of stay and charges than did matched interhospital transfers (i.e., patients transferred to a trauma center from a local hospital; Schwartz et al. ). A study in a rural area found substantial delays, averaging about 70 minutes, between the time of arrival of the patient at a referring emergency department (ED) and the time a request is made by that ED for emergency helicopter transport to a trauma center (Garrison et al., 1989). Despite these findings, the use of helicopters is not systematized. Maryland and Connecticut are among the few states with centralized dispatch of helicopters.
Paramedic EMS in the treatment of prehospital cardiopulmonary arrest were found to be more cost-effective than heart, liver, and bone marrow transplantation and chemotherapy for acute leukemia (Valenzuela et al., 1990). Likewise, early, aggressive, and expert application of rehabilitation in brain injury and spinal cord injury patients is associated with economic savings (Cope and O'Lear, 1993). Much research remains to be performed on the cost-effectiveness of rehabilitation services for many other types of injuries (U.S. DHHS, 1992; IOM, 1997a).