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

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

Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40 % of all trauma deaths. Health care 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. 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 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 1 in Wales). Resource use data were costed using national unit costs and mean costs estimated for the cohort and for clinically relevant sub-groups. Using nationally available data on trauma presentations in England, patient-level cost estimates were up-scaled to a national level. The mean (95 % CI) 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 £148.3 m, with over a third of this cost attributable to patients aged 65 years and over. Severely bleeding major trauma patients are a high cost sub-group 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.