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Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial

  • Emergency Radiology
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Abstract

Objective

To determine the cost-effectiveness of trauma room CT compared with CT performed at the radiology department.

Methods

In this randomised controlled trial, adult patients requiring evaluation in a level 1 trauma centre were included. In the intervention hospital the CT system was located within the trauma room and in the control hospital within the radiology department. Direct and indirect medical costs of the institutionalised stay and diagnostic and therapeutic procedures were calculated.

Results

A total of 1,124 patients were randomised with comparable demographic characteristics. Mean number of non-institutionalised days alive was 322.5 in the intervention group (95 % CI 314–331) and 320.7 in the control group (95 % CI 312.1–329.2). Mean costs of diagnostic and therapeutic procedures per hospital inpatient day were €554 for the intervention group and €468 for the control group. Total mean costs in the intervention group were €16,002 (95 % CI 13,075–18,929) and €16,635 (95 % CI 13,528–19,743) for the control group (P = 0.77).

Conclusion

The present study showed that in trauma patients the setting with a CT system located in the trauma room did not provide any advantages or disadvantages from a health economics perspective over a CT system located in the radiology department.

Key Points

• Computed tomography has become increasingly important in patients who have suffered trauma.

• Emergency departments either use embedded CT facilities or CT machines in the radiology department.

• The cost-effectiveness of CT was not influenced by the location of CT.

• The number of non-institutionalised days alive was not influenced by the location.

• Further assessment of optimal location of CT units is required.

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Acknowledgments

This trial was funded by an unrestricted grant from ZonMw, the Netherlands organization for health research and development (grant number 3920.0005). We would like to thank the REACT trial Advisory Committee for their input and efforts during the design, preparation and conduction of the trial. The authors kindly thank M.G.T. Beentjes, G.F. Giannakopoulos, J. Mouthaan, M. Scholing and K.J. Vos for their efforts and advice in relation to data collection. We thank all prehospital personnel and trauma care organizations for their cooperation and efforts in enabling the conduction of this study.

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Authors and Affiliations

  1. Trauma Unit Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

    T. P. Saltzherr & J. C. Goslings

  2. Department of Traumatology, VU University Medical Center, Amsterdam, the Netherlands

    F. C. Bakker

  3. Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands

    L. F. M. Beenen

  4. Department of Psychiatry, Academic Medical Center, AMC de Meren, Amsterdam, the Netherlands

    M. Olff

  5. Economics Department, VU University Medical Center, Amsterdam, the Netherlands

    K. Meijssen

  6. Concern Staff Department, Academic Medical Center, Amsterdam, the Netherlands

    F. F. Asselman

  7. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands

    J. B. Reitsma

  8. Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands

    M. G. W. Dijkgraaf

Authors
  1. T. P. Saltzherr
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  2. J. C. Goslings
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  3. F. C. Bakker
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  4. L. F. M. Beenen
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  5. M. Olff
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  6. K. Meijssen
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  7. F. F. Asselman
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  8. J. B. Reitsma
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  9. M. G. W. Dijkgraaf
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Consortia

on behalf of the REACT study group

Corresponding author

Correspondence to T. P. Saltzherr.

Additional information

Members of the REACT study group are P.M.M. Bossuyt, P.H.P. Fung Kon Jin, C.P. Henny, G. Koole, J.S.K. Luitse and K.J. Ponsen.

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Saltzherr, T.P., Goslings, J.C., Bakker, F.C. et al. Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial. Eur Radiol 23, 148–155 (2013). https://doi.org/10.1007/s00330-012-2593-0

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  • DOI: https://doi.org/10.1007/s00330-012-2593-0

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