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). 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. 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. The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

中文翻译：

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重伤混合急诊室系统的成本效益：日本第三方支付者视角下的卫生技术评估

据报道，由创伤复苏室中的血管造影计算机断层扫描 (CT) 机组成的混合急诊室 (ER) 系统可有效减少创伤患者因失血而导致的死亡。我们旨在调查混合 ER 系统在没有严重创伤性脑损伤 (TBI) 的严重创伤患者中的成本效益。我们从日本第三方医疗保健支付者的角度进行了成本效用分析，将混合 ER 系统与传统 ER 系统进行了比较。构建了一个短期决策树和一个使用终生时间范围的长期马尔可夫模型来估计质量调整生命年 (QALY) 和相关的终生医疗保健成本。短期死亡率和医疗保健费用来自具有混合急诊室的三级医院的医疗记录和索赔数据。从文献中推断出长期死亡率和效用。支付意愿门槛设定为每获得 QALY 47,619 美元，贴现率为 2%。进行了确定性和概率敏感性分析。与传统 ER 系统相比，混合 ER 系统与 1.03 QALY 的收益和 33,591 美元的生命周期成本增加相关，导致每 QALY 获得 32,522 美元的 ICER。如果 28 天死亡率的优势比 < 0.66，则 ICER 低于支付意愿阈值。概率敏感性分析表明，混合 ER 系统具有成本效益，概率为 79.3%。本研究表明，混合 ER 系统可能是治疗没有严重 TBI 的严重创伤患者的一种可能具有成本效益的策略。