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The variation of acute treatment costs of trauma in high-income countries

  • Lynsey Willenberg1Email author,
  • Kate Curtis2, 3,
  • Colman Taylor1,
  • Stephen Jan1,
  • Parisa Glass1 and
  • John Myburgh1, 3, 4
BMC Health Services Research201212:267

DOI: 10.1186/1472-6963-12-267

Received: 19 April 2012

Accepted: 14 August 2012

Published: 21 August 2012

Abstract

Background

In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries.

Methods

A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities.

Results

A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age.

Conclusion

The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the treatment costs. Targeted research into the costs of trauma care is required to facilitate informed health service planning.

Keywords

Wounds and injuries Hospital costs Economics Medical Cost allocations Cost and cost analysis

Background

The World Health Organisation estimates that approximately 5.8 million people die worldwide each year from injury, accounting for 11% of global mortality [1]. By 2030, road traffic injuries are estimated to be the fifth leading cause of death and the third leading cause of disability worldwide [1]. Injury impacts society significantly on a physical, psychological and economical level [2], costing an estimated US$518 billion globally [3].

Trauma systems have been established in most developed countries [4]. The aim of a trauma system is to facilitate treatment of severely injured patients at a hospital with the appropriate resources. This approach has been demonstrated to significantly reduce trauma patient morbidity in Australia [57] and internationally [5, 79].

In single-payer health systems using episode-funding models, hospitals are reimbursed according to case mix, which may result in underfunding [1012]. Due to the variability in injury severity, averaging patient costs is problematic and diagnostic-related groups do not adequately represent trauma patient episodes [12]. This is particularly relevant to designated trauma centres, which receive the highest proportion of major trauma patients.

Investigations into economic implications of treating trauma patients have focused on specific injuries, regions and age groups; however there has been no comprehensive synthesis of previous research. Accurate economic data relating to the cost of treating injury and identifying factors of high treatment costs are integral to identifying potential levers for policy makers and planners to design more efficient services. The aim of this study was to provide a synthesis of previous research into the cost of treating trauma from the perspective of the receiving hospital. In doing so, we consider the variation in reported costs according to country, trauma subgroups, predictors of cost and the costing methods employed.

Methods

Retrieval of articles

An integrated systematic literature search was conducted to find data that estimated the cost of an acute trauma admission to a designated trauma centre or hospital. The key word search was conducted in Medline, EMBASE, SCOPUS and Google Scholar using adapted search strings (Table 1). Additional searches were conducted in specialised databases such as National Health Service Health Economics Evaluation Database and reports such as the National Health studies and World Health Organisation. Reference lists of identified articles were scanned to extract any additional articles not found using the search string (Figure 1).
Table 1

The cost of trauma key word search

Term

 

POPULATION

#1

exp. Wounds and injuries (MeSH)

#2

((acute or severe) adj3 (trauma or injury or injuries)).mp

INTERVENTION/EXPOSURE

#3

Trauma Centers/

#4

exp. Emergency Service, Hospital/

OUTCOME

#5

Economics, Hospital/

#6

Hospital Costs/

#7

“Costs and Cost Analysis”/

#8

exp Diagnosis-Related Groups/

#9

((cost* or burden*) adj3 (hospital* or “trauma centre*”)).mp

SEARCH STRATEGY

#10

1 OR 2

#11

3 OR 4

#12

5 OR 6 OR 7 OR 8 OR 9

#13

10 AND 11 AND 12

Total

443

https://static-content.springer.com/image/art%3A10.1186%2F1472-6963-12-267/MediaObjects/12913_2012_Article_2310_Fig1_HTML.jpg
Figure 1

Review flow chart prisma diagram/screening process.

Article inclusion

Articles were included in the primary screen if they estimated costs or charges of an acute trauma admission in a designated trauma centre or hospital and provided costing methods. Studies were excluded according to the following criteria: 1) were not specific to humans 2) did not relate to an injury/trauma 3) did not capture the acute patient hospitalisation episode in a designated trauma centre OR hospital department 4) did not provide per patient cost or charge estimates for an acute trauma admission and 5) did not provide costing methods and/or analysis.

For the purpose of this review, costs were considered to be based on resource consumption relating to the delivery of health care such as medications, overheads, administration and equipment used by the hospital [13, 14]. In contrast, charges refer to a list of prices the hospital allocates for particular services, which includes the costs incurred as well as any losses the hospital makes [1315].

Data extraction

Publications that provided per-patient cost or charge data, costing methods and focused on the acute treatment phase of trauma underwent review. Data extracted included: author, year, study aim, study design, location of study, study methods, patient descriptors (age, sex), injury severity score (ISS) [16], type of injury, patient outcomes (length of stay and mortality), cost and charge estimates and cost estimation evaluation, factors associated with cost and reimbursement. No restriction on article language was applied and translations of non-English articles were obtained.

Secondary article exclusion

Following data extraction by the primary author, a subsequent independent analysis was undertaken by two co-authors (KC & CT). The second screening excluded studies that did not capture the cost of the whole acute episode of hospitalisation (e.g. examined only the intensive care unit (ICU) admission) or provided ISS (which would enable comparison between studies). The ISS is a system of injury stratification based on anatomic diagnosis using the Abbreviated Injury Score [16]. An ISS greater than 15 represents severe injury [16]. Awareness searches were conducted throughout the review to identify further relevant papers. Data were grouped into the subgroups of polytrauma (multiple body regions injured), blunt and penetrating mechanisms.

Study assessment

The method for estimating cost in each study was assessed, extracted and categorised (Table 2). Costing methods were classified according to which items were included and excluded (e.g. maintenance costs or physician charges), as well as how these items were measured and valued. These items were further grouped into variable and fixed costs. Variable costs were defined as costs that vary with the level of output whereas fixed costs are costs that vary with time rather than quantity [13]. All monetary values were indexed to 2011 cost equivalents of their respective countries. Purchasing power parities adjustments were subsequently used for those studies that did not present original data in US dollars [1720]. Purchasing power parities is an economic theory used to adjust exchange rates between two countries in order to maintain a constant purchasing power [21].
Table 2

The estimation of cost evaluation

Cost estimation evaluation

Number of studies

Included

 

Variable costs

 

Surgical procedures

11

Materials and supply costs

5

Length of stay (A&E, general ward, ICU)

6

Days spent on mechanical ventilation

2

Maintenance

1

Salaries

4

Reimbursements

3

Transportation

2

Laboratory services

8

Radiology services

4

Pharmacy services

2

Emergency services

2

Pathology services

8

Fixed costs

 

Overheads

4

Depreciation

1

Unspecified

4

Excluded

 

Physician charges

5

Nursing costs

1

Specialist and ancillary services

3

Non-medical resources

5

Pre-clinical emergency

4

Post patient rehabilitation

3

Food and medication costs

1

General hospital overheads

2

Unspecified

15

Measured

 

Medical records

9

Trauma registry

12

Audit of medical records

1

Local government departments

1

Health plan database

1

Unspecified

3

Valued

 

Cost accounting system

7

Reimbursement data

3

Hospital billed charges

2

National cost utilisation project

1

Hospital finance department

7

Local health departments

2

Cost source websites

2

Hospital cost to charge ratio

1

Unspecified

2

Analysis

Analysis was restricted to descriptive statistics of the costing data. The median, interquartile ranges, means and standard deviation of monetary values were extracted from each study and grouped by mechanism of injury (polytrauma, penetrating and blunt) and injury severity (ISS > 15 and ISS < 15) (Table 3). The data in each subgroup were used to calculate the medians and interquartile ranges.
Table 3

Summary of international studies reporting the acute costs of trauma

Author (year)

Country

Number of participants (n)

Type of trauma

Mean ISS

Mean cost per trauma admission ($USD)

Mean charge per trauma admission ($USD)

Thomas (1988)

USA

340

Polytrauma

26+/-17

33701+/-36843

 

Buckley (1994)

USA

805

Polytrauma

10.9

 

16666

Mock (1994)

USA

GSW: 1116

Penetrating

GSW: 13.7

 

GSW:23313+/-42504

SW: 529

SW: 7.6

SW: 10334+/-117939

Kizer (1995)

USA

750

Penetrating

13(1-50)

22115

 

10*

12768*

Spaite (1995)

USA

BAL=>0mg/dL:29

Polytrauma

Group 1:10.3

 

Group 1: 11553; (89-209975)

BAL=0mg/dL:321

Group 2: 33

Group 2: 1875; (56-71448)

Goldfarb (1996)

USA

6963

Polytrauma

18.31+/-6.01

 

29598

27349*

OKeefe (1997)

USA

12088

Polytrauma Blunt Penetrating

11.2+/-9.1

23399+/-37134

 

Rogers (1997)

USA

1179

Poiytrauma

96+/-7.8

ISS 0-16: 8666

 

ISS 17-25: 22979

ISS>25: 57559

Young (1998)

USA

Group I (18-64 yr): 828

Polytrauma

Group 1: 13.8+/-10.7

Group 1: 24970 +/-4235

 

Group 2 (>65yr):159

Group 2: 162+/-11.1

Group 2:21602 +/- 37922

Taheri (1998)

USA

361

Polytrauma

Group 1: 14.4+/-0.5

Group 1: 15053

 

Group 2: 14.7+/-0.5

Group 2: 11036

Sartorelli (1999)

USA

1179

Polytrauma

7.2+/-7.6

12988+/-21549

 

Kaya (1999)

Turkey

347

Polytrauma

13.3+/-0.5

 

69839

Taheri (1999)

USA

696

Polytrauma

>15

14564

 

Rösch (2000)

Germany

39

Polytrauma

37

111209

 

Dueck (2001)

Canada

223

Polytrauma

18.8

8196

 
     

5226*

 

Park (2001)

USA

204

Polytrauma

TICU:25.8+/-7.9

TICU: 173013; 119397*

 

SICU:27.1+/-9.2

SICU:211130; 166653*

Schmelz (2002)

Germany

71

Polytrauma

23

32851

 

Ganzonie (2003)

Switzerland

35

Polytrauma

33.9 (25-66)

95380

 

Lanzorotti (2003)

USA

2634

Polytrauma

11.9 +/- 9.2 (1-75)

 

13096+/- 27003; (837-418553)

Grotz (2003)

Germany

103

Polytrauma

29.4

41522

 

Sikand (2005)

UK

171

Polytrauma

>15

27542; (3216-96558)

 

Small (2006)

Australia

180

Pedestrian

14.1

22713

 

Davis (2007)

USA

12615

Blunt Penetrating & TBI

10.67

 

60094

Christensen (2008)

UK

36564

Blunt

ISS 0-9: 60%

ISS 0-9: 11248; 8471*

 

ISS 10-16: 17%

ISS 10-16: 16313; 10330

ISS 17-25: 12%

ISS 17-25: 25780; 16123

1SS26-75: 11%

ISS 26- 75: 38426; 27297

Total: 17295+/-21546; 9782* (6580-17812)

Christensen (2008)

UK

1365

Penetrating

ISS 1-8:16%

ISS 1-8: 11798;

 

ISS 9-15: 50%

8580*

ISS 16-24: 15%

ISS 9-15: 10952; 8568*

ISS 25-45: 16%

ISS 16-24: 17155; 13099*

ISS 46-75: 41%

ISS 25-45: 22408; 13386*

ISS 46-75: 29832; 19551*

Total: 14488; 9932* (5976-16034)

Zarzaur (2010)

USA

1914

Blunt

23.3 +/- 7.2

11541 +/-18681 5620*

 

Rowell (2011)

Australia

72

Polytrauma

28.13+/-9.92

43547 34350*

 

*Median costs, Blood alcohol level (BAL), Gunshot wounds (GSW), Stab wounds (SW), Surgical Intensive Care Unit (SICU), Trauma Intensive Care Unit (TICU).

Results

The search strategy yielded 443 studies of which 27 were included in the final analysis (Figure 1). Four of these articles were published in non-English languages and were translated into English. Sixteen (61.5%) studies were conducted in USA [2236], three (11.5%) in the UK [3739] and Germany [4042] and two (7.7%) in Australia [43], and one (3.7%) in Switzerland [44] Turkey [45] and Canada [46] respectively (Table 4). Costs and charges were used interchangeably, which created difficulty in evaluating the results of the studies as charges typically vary from costs. Table 4 shows the overall median (interquartile range – IQR) cost of major trauma calculated from the 20 studies (70.1%) reporting cost estimates was $22,448 (IQR $11,819-$33,701). Seven studies (25.9%) reported charges ($26,030; IQR $13,988-$28,199). The median cost of major trauma in the USA was $22,115 (IQR $13,776-$29,335) Australia $33,130 (IQR $27,907-$38,297), UK $18,535 (IQR $11,819 - $25,827) and Germany $41,522 (IQR $37,186 -$76,365).
Table 4

Median cost and charge estimates of acute trauma treatment

Country

Number of articles

Median $US cost (IQR)

Median $US charge (IQR)

USA

16

22,115 (13,776-29,335)

14,881 (8,219- 27,523)

UK

3

18,535

 
  

(11,819-25,827)

 

Germany

3

41,522 (37,186-76,365)

 

Australia

2

33,130 (27,907-38,297)

 

Switzerland

1

95,380

 

Turkey

1

 

69,839

Canada

1

8,196

 

Total

27

*22,448 (11,819-33,701)

**26,030 (13,988-28,199)

*Median cost (IQR) across studies (all countries).

**Median charge (IQR) across studies (all countries).

Subgroups associated with costs

Results varied according to the type of trauma reported. In the polytrauma sub-groups the median cost was $26,521 per patient (IQR $14,686-$43,000). Studies [25, 26, 37] that reported only penetrating trauma had a median cost of $19,651 per patient (IQR $13,161-$22,365). Two studies [38, 47] specifically reported blunt trauma, estimating a median per patient cost of $16,342 (IQR $11,541-$25,827) (Figure 2). Three studies [33, 46, 48] reported the cost of components associated with treatment costs. These included the cost of staff, emergency department services, pharmaceuticals and radiology.
https://static-content.springer.com/image/art%3A10.1186%2F1472-6963-12-267/MediaObjects/12913_2012_Article_2310_Fig2_HTML.jpg
Figure 2

Acute trauma treatment costs per subgroup.

Charge estimates were also reported by type of trauma (Figure 3). The median charge for polytrauma patients was $27,289 (IQR $19,311-$35,417). In patients with penetrating trauma the median charge per patient was $16,666 (IQR $13,500-$19,990).
https://static-content.springer.com/image/art%3A10.1186%2F1472-6963-12-267/MediaObjects/12913_2012_Article_2310_Fig3_HTML.jpg
Figure 3

Acute trauma treatment charges per subgroup.

All studies provided ISS scores to characterise the injury severity of the included patient population. For studies with an average ISS ≥ 15, median cost was $29,886 (IQR $22,581-$40,009) and the median charge was $27,347 (IQR $26,724-$28,199). In studies reporting an average ISS ≤ 15 the median cost was $12,988 (IQR $11,152- $19,229) and median charge was $14,881 (IQR $11,248-$32,508).

Predictors of cost

Six studies (22%) [22, 30, 35, 37, 38, 46] used multivariate analyses to determine positive and negative predictors of high treatment costs. Higher treatment costs were associated with polytrauma and specific body regions including the abdomen (OR = 0.65) [35, 37, 38], chest [46], brain (OR = 0.58) [35], thorax, spine [10] and upper and lower limbs [38]. Other factors that were found to influence treatment costs included: mode of hospital arrival- the most expensive being helicopter [38], the presence and type of surgical interventions (anaesthesia, neurosurgery and general surgery, wound debridement and intracranial procedures) [22, 38, 46], the type of treating physician e.g. consultants [38], designated trauma centre level [22], ICU and hospital length of stay [22, 30], age [38], road traffic collisions [38] and higher ISS scores [37, 38]. Hospital mortality was negatively associated with treatment costs [37, 38]. The potential causes of these predictors of high cost were not explained.

Costing methods

The level of detail provided regarding statistical and costing methods varied between studies. Articles generally provided descriptive analyses of patient cohorts and used a combination of statistical methods. In order to examine differences in cost between groups (such as high and low injury severity), studies used a range of analyses for categorical and continuous outcome measures such as fisher’s exact test and Mann Whitney U test. Other studies used simple linear regression analyses [25, 29, 30, 43, 45, 46] to determine the relationship between cost of care and various patient variables. Studies that further examined the predictors of high treatment costs used multivariate models [37, 38] such as multiple logistic regression analysis [34, 35, 46].

In regards to costing methods, five (18%) studies [27, 30, 33, 39, 40] provided comprehensive costing methods which reported details of included and excluded items as well as how these were measured and valued. Seventeen (63%) studies [11, 27, 30, 3234, 3740, 42, 43, 45, 46, 4850] provided information regarding items included in cost or charge estimates and fourteen (52%) studies [22, 23, 26, 27, 29, 30, 33, 35, 39, 40, 42, 4446] documented what was excluded from cost or charge estimates. Due to the variation in statistical analysis across studies, a meta-analysis was unable to be performed on the data.

Regarding the source of hospital cost information, twenty-one (78%) studies [2335, 3942, 44, 45, 47, 50] used their respective trauma registry or medical records to derive per patient costs and charges and six (22.2%) studies [22, 3638, 43, 46] used alternate sources. Alternate sources included local government department estimates [37, 38], a health plan database [36] and an audit of medical records [46] (Table 2).

Of the twenty-one (78%) studies using hospital data, nineteen (70%) studies [2325, 2735, 3942, 44, 45] used hospital based-accounting systems, of which, 74% reported cost [24, 27, 2934, 3942] estimates and 26% reported charges [28, 44, 45, 51]. The five (19%) studies [27, 29, 31, 32, 49] that used hospital accounting systems, specified the accounting system methodology. The remaining three studies, [26, 47, 50] which used hospital data reported costs using cost to charge ratios [47, 50] and reimbursement data [26].

Discussion

This review provides a synthesis of literature concerning the acute treatment costs of trauma in high-income countries and the drivers of higher costs. Results showed the cost of acute treatment was a median of $22,448 across studies (IQR: $11,819-$33,701) and identified factors such as injury severity, surgical interventions, ICU and hospital LOS, were consistently associated with higher treatment costs. Across studies, we identified marked variability in reporting, methods of costing and actual costs and charges [15].

The broad inclusion criteria and time period used in this review resulted in a representative sample, although comparison and ranking of costs between studies was limited due to the variety of costing and statistical methods. The predominance of US data may not be generalisable to universal access health systems such as those in Australia and Canada. Although 90% of the world’s deaths from injuries occur in developing countries [51], there is limited external validity of our results outside the high-income countries, where the reviewed studies were conducted. Further, this is the first review to focus on describing the cost of trauma treatment to hospitals. The economic burden of trauma in post-acute care, requires further investigation [52].

The primary drivers of variations in treatment costs between studies were the variety of patient populations studied and the cost methods employed. Drummond et al. [13] identified two fundamental elements for accurate micro-costing; the measurement of the quantities of resource use and assignment of unit costs or prices. Only five studies provided comprehensive methods behind their cost estimates and the majority of studies collected resource use and unit costs in various ways.

The second driver in the variation in cost estimates between studies identified in our review was the use of cost versus charge estimates. Cost estimates vary in accuracy depending on methods of hospital accounting systems that inform episode funding models, with the consequence that true costs may be under-represented in trauma patients [12, 41, 53, 54]. Conversely, charges generally overestimate actual costs, as hospitals anticipate the trajectory of costs and payments to the hospital each year [55]. As a result, charges do not necessarily give a good indication of what a hospital pays for the resources it consumes in providing services. Adequate funding of trauma centres is essential to enable high quality of care [56] and subsequent patient survival and long term function [57].

Further research focusing on trauma treatment costs and factors associated with higher costs is necessary. Mechanism of injury as a predictor of cost was poorly quantified, some studies reported the high incidents of falls, but did not relate their findings to the cost of treatment. However the association of road trauma with high treatment costs [38] is symptomatic of the global proliferation of road injury [1]. There were inconsistencies associated with high treatment costs and age range, likely due to the variation in ISS and mechanism of injury, although the peak in costs in older patients could be a result of increased falls [58] exacerbated by in-hospital complications and chronic diseases [59]. In comparison to other disease classifications, such as stroke, where the median in-hospital cost is $14,571 (IQR $468 to $146,149) our study demonstrated trauma was substantially more expensive [57].

In an environment of growing cost pressures, new technologies, aging population and consumer expectations, treatment costs and the economic burden to healthcare systems will increase [60]. Accurate economic data is fundamental for improving current funding models and promoting the efficient delivery of services. There remain large gaps in the knowledge around trauma care costs. Health services need to determine if trauma care costs are commensurate with current funding models and funded adequately. Policy makers need to consider if the current modes of trauma care delivery provide sufficient value [60].

Conclusion

The acute treatment cost of trauma is higher than other disease groups and increases with injury severity, age, surgical intervention and polytrauma. Reported costs differ considerably due to variations in injury type and the inconsistency in study methods. The true costs of trauma to a trauma centre requires further investigation to ensure informed planning and delivery of services.

Abbreviations

AIS: 

Abbreviated injury score

ISS: 

Injury severity score

ICU: 

Intensive care unit

IQR: 

Interquartile range.

Declarations

Acknowledgements

We thank Manuela Armenis who translated the German and Swiss studies to English.

Authors’ Affiliations

(1)
The George Institute for Global Health
(2)
Sydney nursing school, University of Sydney
(3)
St George Hospital
(4)
Faculty of Medicine, University of New South Wales

References

  1. World Health Organization: Global status report on road safety: time for action. 2009, Geneva: WHOGoogle Scholar
  2. Lyons RA, Finch CF, McClure R, van Beeck E, Macey S: The injury list of all deficits (LOAD) framework - conceptualising the full range of deficits and adverse outcomes following injury and violence. Int J Inj Control Saf Promot. 2010, 17 (3): 145-159. 10.1080/17457300903453104.View ArticleGoogle Scholar
  3. Peden M, McGee K, et al: Injury: a leading cause of the global burden of disease, 2000. 2002, Geneva: World Health OrganizationGoogle Scholar
  4. Roudsari BS, Nathens AB, Cameron P, Civil I, Gruen RL, Koepsell TD, Lecky FE, Lefering RL, Liberman M, Mock CN, et al: International comparison of prehospital trauma care systems. Injury. 2007, 38 (9): 993-1000. 10.1016/j.injury.2007.03.028.View ArticlePubMedGoogle Scholar
  5. Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, Flint L: A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. Journal of Trauma - Injury, Infection and Critical Care. 2006, 60 (2): 371-378. 10.1097/01.ta.0000197916.99629.eb.View ArticleGoogle Scholar
  6. Brennan PW, Everest ER, Griggs WM, Slater A, Carter L, Lee C, Semmens JK, Wood DJ, Nguyen AMT, Owen DL, et al: Risk of death among cases attending South Australian major trauma services after severe trauma: The first 4 years of operation of a state trauma system. Journal of Trauma - Injury, Infection and Critical Care. 2002, 53 (2): 333-339. 10.1097/00005373-200208000-00024.View ArticleGoogle Scholar
  7. Papa L, Langland-Orban B, Kallenborn C: Assessing effectiveness of a mature trauma system: Association of trauma center presence with lower injury mortality rate. Journal of Trauma. 2006, 61 (2): 261-266. 10.1097/01.ta.0000221789.53864.ba.View ArticlePubMedGoogle Scholar
  8. Twijnstra MJ, Moons KGM, Simmermacher RKJ, Leenen LPH: Regional trauma system reduces mortality and changes admission rates: a before and after study. Ann Surg. 2010, 251 (2): 339-343. 10.1097/SLA.0b013e3181c0e910.View ArticlePubMedGoogle Scholar
  9. Westhoff J, Hildebrand F, Grotz M, Richter M, Pape HC, Krettek C: Trauma care in Germany. Injury. 2003, 34 (9): 674-683. 10.1016/S0020-1383(03)00147-5.View ArticlePubMedGoogle Scholar
  10. Curtis K, Dickson C, Black D, Nau T: The cost and compensability of trauma patients. Aust Heal Rev. 2009, 33 (1): 84-92. 10.1071/AH090084.View ArticleGoogle Scholar
  11. Grotz M, Schwermann T, Lefering R, Ruchholtz S, Schulenburg JMGVD, Krettek C, Pape HC: G-DRG reimbursement for polytrauma patients - A comparison with the comprehensive hospital costs using the german trauma registry. DRG-entlohnung beim polytrauma - Ein vergleich mit den tatsächlichen krankenhauskosten anhand des DGU-traumaregisters. 2004, 107 (1): 68-75.Google Scholar
  12. Curtis K, Mitchell R, Dickson C, Black D, Lam M: Do AR-DRGs adequately describe the trauma patient episode in New South Wales, Australia?. Health Information Management Journal. 2011, 40 (1): 7-13.View ArticlePubMedGoogle Scholar
  13. Drummond MF, Sculpher MJ, Torrance GW: Methods for the economic evaluation of health care programmes. 2005, USA: Oxford University PressGoogle Scholar
  14. Health Economics Information Resources. http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html.
  15. Finkler SA: The distinction between cost and charges. Ann Intern Med. 1982, 96 (1): 102-109.View ArticlePubMedGoogle Scholar
  16. Palmer CS, Niggemeyer LE, et al: Double coding and mapping using Abbreviated Injury Scale 1998 and 2005: Identifying issues for trauma data. Injury. 2010, 41 (9): 948-954. 10.1016/j.injury.2009.12.016.View ArticlePubMedGoogle Scholar
  17. Reserve Bank of Australia: Inflation Calculator. http://www.rba.gov.au/calculator/.
  18. U.S Bureau of Labor Statistics: CPI Inflation calculator. http://www.bls.gov/data/inflation_calculator.htm.
  19. Inflation Calculator. http://www.bankofcanada.ca/rates/related/inflation-calculator/?page_moved=1.
  20. OECD Stat. Extracts. http://stats.oecd.org/Index.aspx?datasetcode=SNA_TABLE4.
  21. Begg D, Fischer S, Dornbusch R: Economics. 2008, Berkshire: McGraw-Hill Higher Education, 9Google Scholar
  22. Goldfarb M, Bazzoli G, Coffey R: Trauma systems and the costs of trauma care. Health Systems Research. 1996, 31 (1): 71-95.Google Scholar
  23. Buckley SL, Gotschall C, Robertson W, Sturm P, Tosi L, Thomas M, Eichelberger M: The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop. 1994, 14 (4): 449-453. 10.1097/01241398-199407000-00005.View ArticlePubMedGoogle Scholar
  24. Thomas F, Clemmer TP, Larsen KG, Menlove RL, Orme JF, Christison EA: The economic impact of DRG payment policies on air-evacuated trauma patients. Journal of Trauma-Injury Infection & Critical Care. 1988, 28 (4): 446-452. 10.1097/00005373-198804000-00005.View ArticleGoogle Scholar
  25. Mock C, Pilcher S, Maier R, Britt LD, Hawkins MB, Fildes J, Weigelt JA: Comparison of the costs of acute treatment for gunshot and stab wounds: Further evidence of the need for firearms control. Journal of Trauma. 1994, 36 (4): 516-522. 10.1097/00005373-199404000-00010.View ArticlePubMedGoogle Scholar
  26. O’Keefe GE, Maier RV, Diehr P, Grossman D, Jurkovich GJ, Conrad D: The complications of trauma and their associated costs in a level I trauma center. Arch Surg. 1997, 132 (8): 920-924. 10.1001/archsurg.1997.01430320122021. discussion 925View ArticlePubMedGoogle Scholar
  27. Kizer KW, Vassar MJ, Harry RL, Layton KD: Hospitalization charges, costs, and income for firearm-related injuries at a university trauma center. JAMA. 1995, 273 (22): 1768-1773. 10.1001/jama.1995.03520460050034.View ArticlePubMedGoogle Scholar
  28. Spaite DW, Criss EA, Weist DJ, Valenzuela TD, Judkins D, Meislin HW: A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma. Journal of Trauma - Injury, Infection and Critical Care. 1995, 38 (2): 287-290. 10.1097/00005373-199502000-00028.View ArticleGoogle Scholar
  29. Rogers FB, Osler TM, Shackford SR, Cohen M, Camp L: Financial outcome of treating trauma in a rural environment. Journal of Trauma-Injury Infection & Critical Care. 1997, 43 (1): 65-72. 10.1097/00005373-199707000-00016. discussion 72–63View ArticleGoogle Scholar
  30. Sartorelli KH, Rogers FB, Osler TM, Shackford SR, Cohen M, Vane DW: Financial aspects of providing trauma care at the extremes of life. Journal of Trauma-Injury Infection & Critical Care. 1999, 46 (3): 483-487. 10.1097/00005373-199903000-00025.View ArticleGoogle Scholar
  31. Young JS, Cephas GA, Blow O: Outcome and cost of trauma among the elderly: a real-life model of a single-payer reimbursement system. Journal of Trauma-Injury Infection & Critical Care. 1998, 45 (4): 800-804. 10.1097/00005373-199810000-00033.View ArticleGoogle Scholar
  32. Taheri PA, Butz DA, Watts CM, Griffes LC, Greenfield LJ: Trauma services: a profit center?. J Am Coll Surg. 1999, 188 (4): 349-354. 10.1016/S1072-7515(99)00021-6.View ArticlePubMedGoogle Scholar
  33. Taheri PA, Wahl WL, Butz DA, Iteld LH, Michaels AJ, Griffes LC, Bishop G, Greenfield LJ: Trauma service cost: The real story. Ann Surg. 1998, 227 (5): 720-725. 10.1097/00000658-199805000-00012.View ArticlePubMedPubMed CentralGoogle Scholar
  34. Park CA, McGwin G, Smith DR, May AK, Melton SM, Taylor AJ, Rue LW: Trauma-specific intensive care units can be cost effective and contribute to reduced hospital length of stay. Am Surg. 2001, 67 (7): 665-670.PubMedGoogle Scholar
  35. Lanzarotti S, Cook CS, Porter JM, Judkins DG, Williams MD: The cost of trauma. Am Surg. 2003, 69 (9): 766-770.PubMedGoogle Scholar
  36. Davis KL, Joshi AV, Tortella BJ, Candrilli SD: The direct economic burden of blunt and penetrating trauma in a managed care population. Journal of Trauma - Injury, Infection and Critical Care. 2007, 62 (3): 622-629. 10.1097/TA.0b013e318031afe3.View ArticleGoogle Scholar
  37. Christensen MC, Nielsen TG, Ridley S, Lecky FE, Morris S: Outcomes and costs of penetrating trauma injury in England and Wales. Injury. 2008, 39 (9): 1013-1025. 10.1016/j.injury.2008.01.012.View ArticlePubMedGoogle Scholar
  38. Christensen MC, Ridley S, et al: Outcomes and costs of blunt trauma in England and Wales. Critical Care. 2008, 12 (1): R23-10.1186/cc6797.View ArticlePubMedPubMed CentralGoogle Scholar
  39. Sikand M, Williams K, White C, Moran C: The financial cost of treating polytrauma: implications for tertiary referral centres in the United Kingdom. Injury. 2005, 36 (6): 733-737. 10.1016/j.injury.2004.12.026.View ArticlePubMedGoogle Scholar
  40. Schmelz A, Ziegler D, Beck A, Kinzl L, Gebhard F: Costs for acute, stationary treatment of polytrauma patients. Akutstationáre behandlungskosten polytraumatisierter patienten. 2002, 105 (11): 1043-1048.Google Scholar
  41. Grotz MST, Lefering R, Ruchholtz S, Schulenburg JM Gvd, Krettek C, Pape HC: G-DRG reimbursement for polytrauma patients – a comparison with the comprehensive hospital costs using the german trauma registry. Unfallchirurg. 2004, 107 (1): 68-75. 10.1007/s00113-003-0715-5.View ArticlePubMedGoogle Scholar
  42. Rösch MKT, Leidl R, Gebhard F, Kinzl L, Ebinger T: Cost analysis of the treatment of patients with multiple trauma. Unfallchirurg. 2000, 203 (8): 632-639.View ArticleGoogle Scholar
  43. Rowell D, Connelly L, Webber J, Tippett V, Thiele DMS: What are the true costs of major trauma?. Journal of Trauma. 2011, 70 (5): 1086-1095. 10.1097/TA.0b013e3181ed4d29.View ArticlePubMedGoogle Scholar
  44. Ganzoni D, Zellweger ROT: Cost analysis of acute therapy of polytrauma patients. Swiss Surgery. 2003, 9 (6): 268-274. 10.1024/1023-9332.9.6.268.View ArticlePubMedGoogle Scholar
  45. Kaya E, Ozguc H, Tokyay R, Yunuk O: Financial burden of trauma care on a university hospital in a developing country. Journal of Trauma - Injury, Infection and Critical Care. 1999, 47 (3): 572-575. 10.1097/00005373-199909000-00027.View ArticleGoogle Scholar
  46. Dueck A, Poenaru D, Pichora DR: Cost factors in Canadian pediatric trauma. Can J Surg. 2001, 44 (2): 117-121.PubMedPubMed CentralGoogle Scholar
  47. Zarzaur BL, Magnotti LJ, Croce MA, Haider AH, Fabian TC: Long-Term Survival and Return On Investment After Nonneurologic Injury: Implications for the Elderly Trauma Patient. The Journal of Trauma. 2010, 69 (1): 93-10.1097/TA.0b013e3181df6734.View ArticlePubMedGoogle Scholar
  48. Ganzoni D, Zellweger R, Trentz O: Cost analysis of acute therapy of polytrauma patients]. Swiss surgery= Schweizer Chirurgie= Chirurgie suisse= Chirurgia svizzera. 2003, 9 (6): 268-10.1024/1023-9332.9.6.268.View ArticlePubMedGoogle Scholar
  49. Thomas F, Clemmer TP, Larsen KG, Menlove RL, Orme JF, Christion EA: The economic impact of DRG payment policies on air-evacuated trauma patients. Journal of Trauma. 1988, 28 (4): 446-452. 10.1097/00005373-198804000-00005.View ArticlePubMedGoogle Scholar
  50. Small TJ, Sheedy JM, Grabs AJ: Cost, demographics and injury profile of adult pedestrian trauma in inner Sydney. ANZ J Surg. 2006, 76 (1–2): 43-47.View ArticlePubMedGoogle Scholar
  51. Hofman K, Primack A, Keusch G, Hrynkow S: Addressing the growing burden of trauma and injury in low-and middle-income countries. Am J Public Health. 2005, 95 (1): 13-10.2105/AJPH.2004.039354.View ArticlePubMedPubMed CentralGoogle Scholar
  52. Polinder S, Haagsma JA, et al: Measuring the population burden of fatal and nonfatal injury. Epidemiologic Reviews. 2012, 34 (1): 17-31. 10.1093/epirev/mxr022.View ArticlePubMedGoogle Scholar
  53. Pape HC, Neugebauer E, Ridley SA, Chiara O, Nielsen TG, Christensen MC: Cost-drivers in acute treatment of severe trauma in Europe: A systematic review of literature. European Journal of Trauma and Emergency Surgery. 2009, 35 (1): 61-66. 10.1007/s00068-008-8013-0.View ArticlePubMedGoogle Scholar
  54. Jacobs LM: The effect of prospective reimbursement on trauma patients. Bulletin of the American College of Surgeons. 1985, 70 (2): 17-22.PubMedGoogle Scholar
  55. Hospital charges explained. http://www.passavanthospital.com/_data/files/HospitalChargesExplained12803.pdf.
  56. Rotondo MF, Bard MR, Sagraves SG, Toschlog EA, Schenarts PJ, Goettler CE, Newell MA, Robertson MJ: What price commitment: What benefit? The cost of a saved life in a developing level 1 Trauma Center. Journal of Trauma - Injury, Infection and Critical Care. 2009, 67 (5): 915-921. 10.1097/TA.0b013e3181b848e7.View ArticleGoogle Scholar
  57. Gabbe BJ, Biostat GD, Lecky FE, Bouamra O, Woodford M, Jenks T, Coats TJ, Cameron PA: The effect of an organized trauma system on mortality in major trauma involving serious head injury: A comparison of the United Kingdom and Victoria, Australia. Ann Surg. 2011, 253 (1): 138-143. 10.1097/SLA.0b013e3181f6685b.View ArticlePubMedGoogle Scholar
  58. Watson WL, Ozanne-Smith J, et al: The cost of injury to Victoria. 1997, Melbourne: Monash University Accident Research CentreGoogle Scholar
  59. Allbon P: Health system expenditure on disease and injury in Australia, 2004-05. 2010, Canberra: Australian Institute of Health and WelfareGoogle Scholar
  60. Thomson S, Foubister T, et al: Addressing financial sustainability in health systems. 2009, Denmark: European Observatory on Health Systems and PoliciesGoogle Scholar
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    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/267/prepub

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