One Year Treatment Costs of Trauma Care

Injuries have been estimated to account for approximately 10% of total U.S. medical expenditures. Data from the National Study on the Costs and Outcomes of Trauma (NSCOT) were used to develop a better understanding of the nature of these expenditures for a subgroup of moderately severe and severe injuries. Specifically, we present estimates of the treatment costs of trauma care in the acute setting (the index hospitalization for trauma) and for 12 months following injury. The NSCOT team recruited patients from 18 hospitals with a level 1 trauma center and 51 non-trauma center hospitals located in 14 states in several regions of the country. Patients 18 to 84 years old with a moderate-to-severe injury discharged between July 2001 and November 2002 were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. Analyses employ data weighted to the population of eligible patients to adjust for the sampling protocol, whereby all deaths were included but live discharges were sampled, and to account for the fact that not all cases selected for inclusion were enrolled. Acute and post-acute costs of care were estimated from a combination of data sources: UB92 hospital bills (acute hospitalization), purpose-designed patient surveys conducted at 3- and 12-months post-injury (post-acute health services utilization across settings), and for the elderly sample, Medicare claims (both acute and post-acute utilization across settings). We have data on inpatient stays (acute, rehabilitation and skilled nursing facilities), outpatient physical and occupational therapy, other outpatient care (outpatient hospital care, PCP visits, etc.), home health, and informal care provided by family members. Inpatient charges were stepped down to costs by matching revenue center data from hospital bills with cost-to-charge ratios from the hospital's Medicare Cost Report at the cost department level. Inpatient costs were adjusted using regional wage and capital indexes. Where Medicare claims were available, outpatient costs were estimated as allowed charges. Unit cost estimates were computed from Medstat's MarketScan commercial database, Medicare Cost Reports, AHA data and other sources. All costs are expressed as constant 2005 dollars using appropriate price indices (e.g., Hospital PPI, Nursing Care Facility PPI, Professional Services Component of the CPI for Medical Care). We will present additional detail on our cost estimation methodology. Estimates of treatment costs will be presented by acute versus post-acute care, discharge disposition (hospital death vs. live discharge), age cohort, and type and severity of injury. Finally, we employ national estimates on incidence of traumatic injuries from AHRQ's Health Cost and Utilization Project (HCUP) database to arrive at an estimate of the annual cost of treating major trauma in the United States.

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