O. A. Olufajo1,2, Y. Wang2, W. Jiang2, J. Leow2, Z. Cooper1,2, J. M. Havens1,2, R. Askari1,2, A. H. Haider1,2, J. D. Gates1, A. Salim1,2, E. Kelly1 1Brigham And Women’s Hospital,Division Of Trauma, Burn And Surgical Critical Care, Department Of Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA
Introduction: Splenic artery embolization (SAE) is a well-known adjunct to the non-operative management of blunt splenic injuries (BSI). Although numerous studies have examined clinical outcomes of patients treated with and without SAE, there is a paucity of data that examines the economic impact of these treatment decisions. Our objective was to determine the cost implications of various strategies for non-operative management of BSI.
Methods: Patients with BSI were identified in the TRICARE database (2006 – 2010), a healthcare data repository of active and retired U.S. military personnel and their dependents. Patients who were managed non-operatively were classified as either having splenic artery embolization (SAE) or non-invasive management (NIM). Patients were categorized based on their Injury Severity Scores (ISS). Length of hospital stay, readmission rates, and 30 day complication rate (pneumonia, urinary tract infections, ileus/small bowel obstruction, wound infection, sepsis, acute renal failure) were determined. The 30-day costs of patient care (admission, readmission and complications) were calculated. A decision tree was used to determine the cost-effective strategy for various patient groups. Effectiveness was measured using quality-adjusted life years (QALYs).
Results: There were 529 patients who were managed non-operatively: 41 had SAE and 488 had NIM. The majority of patients were male (78%), < 45 years old (79%), with ISS > 15 (54%). Comparing the SAE to the NIM groups showed similar in-hospital complications (9.80% vs. 10.50%, P > 0.99), lower 30-day readmission rates (2.41% vs. 7.99%, P = 0.350), and similar rates of operation on readmission (0.00% vs. 1.40%, P > 0.99). The costs measured in both groups increased as ISS increased. While the costs in the NIM and SAE groups were $5,882 and $18,766, respectively, for ISS <9, the costs were $19,442 and $35,678, respectively, for ISS >25. Incremental cost-effectiveness ratios of SAE vs. NIM were all above the commonly used willingness-to-pay threshold of $50,000/QALY regardless of the ISS (Table), indicating that NIM was cost-effective compared to SAE.
Conclusion: Our study suggests that the cost of SAE, as a strategy for non-operative BSI management, outweighs its benefits. As emphases on cost implications of patient management increase, these findings can prove useful in cost management in BSI patients.
