Renna, Maxwell S., van Zeller, Cristiano, Abu-Hijleh, Farah, Tong, Cherlyn, Gambini, Jasmine and Ma, Mengyao (2019) A one-year cost–utility analysis of resuscitative endovascular balloon occlusion of the aorta versus resuscitative thoracotomy with aortic cross-clamping for non-compressible torso haemorrhage. Trauma, 21 (1). pp. 45-54. doi:10.1177/1460408617738810

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Abstract

Introduction

Major trauma is a leading cause of death and disability in young adults, especially from massive non- compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemor- rhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service.

Methods

A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ- 5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted.

Results

A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost- effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%.

Conclusion

Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hemorrhage -- Treatment -- Cost effectiveness, Aorta -- Wounds and injuries -- Treatment -- Cost effectiveness
Journal or Publication Title:	Trauma
Publisher:	Sage Publications, Inc.
ISSN:	1477-0350
Official Date:	1 January 2019
Dates:	Date Event 1 January 2019 Published 24 November 2017 Available 30 September 2017 Accepted
Volume:	21
Number:	1
Page Range:	pp. 45-54
DOI:	10.1177/1460408617738810
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access

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