Trauma centres and the efficient use of financial resources
O'Kelly T J, Westaby S
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Specialist trauma centres.
Type of intervention
Treatment.
Economic study type
Cost-effectiveness analysis and cost-utility analysis.
Study population
Severely injured victims in specialist trauma centres.
Setting
The study was carried out in the United Kingdom.
Dates to which data relate
It seems that price related to 1989.
Source of effectiveness data
Review of studies.
Measure of benefits used in the economic analysis
Life years gained and Quality-adjusted life years (QALYs). A Rosser classification was used for the health state description. A Rosser 1 was used as a basic method of valuation of health states. Author values were used to assess the health states.
Direct costs
Direct costs were to the health service and included: junior medical time, nursing, drugs, ITU, ward, ancillary facilities consultant, theatre, and capital. It seems that price information related to 1989.
Currency
UK pounds sterling (). In the DH Register of Cost-Effectiveness Studies, the original results were reflated to 1991 using the NHS pay and prices index.
Sensitivity analysis
No sensitivity analysis was carried out.
Estimated benefits used in the economic analysis
QALYs gained were 9029/1000 patients in one year.
Synthesis of costs and benefits
Outcome duration was life long. Cost duration was 1 year. Costs and benefits were not discounted. Incremental cost per life-year gained for treatment of severely injured victims in specialist trauma centres was 853, and the incremental cost per QALY was 1106.
CRD Commentary
(This commentary was not written by CRD, but by the authors of the DH Register.)
1) It is the opinion of the Royal college of surgeons of England that 2175 lives could be saved each year by trauma centres (272 lives/centre). No good quality evidence is presented to support this. 2) Transfer costs between hospitals are not considered. 3) The costs are not incremental: an implicit conservative assumption that costs cannot be reduced elsewhere. 4) The paper gives no indication that cost data have been reflated to a common year base. 5) The model examines the case for 8 trauma centres in the UK each treating 1000 patients/year. 6) There were no health omissions.
Bibliographic details
O'Kelly T J, Westaby S. Trauma centres and the efficient use of financial resources. British Journal of Surgery 1990; 77(10): 1142-1144
Cost-Benefit Analysis /statistics & Efficiency; Great Britain; Humans; Quality of Life; State Medicine /economics; Trauma Centers /economics; Value of Life; numerical data