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Cost-Effectiveness of the Transmural Trauma Care Model (TTCM) for the Rehabilitation of Trauma Patients

Published online by Cambridge University Press:  24 July 2019

Suzanne H Wiertsema ,
Johanna M van Dongen Open the ORCID record for Johanna M van Dongen [Opens in a new window] ,
Edwin Geleijn ,
Rosalie J Huijsmans ,
Frank W Bloemers ,
Vincent de Groot  and
Raymond WJG Ostelo
Suzanne H Wiertsema*
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Public Health research institute
Johanna M van Dongen
Affiliation:
Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam Public Health research institute
Edwin Geleijn
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine
Rosalie J Huijsmans
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine
Frank W Bloemers
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Trauma Surgery
Vincent de Groot
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Public Health research institute
Raymond WJG Ostelo
Affiliation:
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Department of Health Science, Amsterdam Public Health research institute
*
Author for correspondence: Suzanne Wiertsema, Email: s.wiertsema@vumc.nl
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Abstract

Objectives

To assess the societal cost-effectiveness of the Transmural Trauma Care Model (TTCM), a multidisciplinary transmural rehabilitation model for trauma patients, compared with regular care.

Methods

The economic evaluation was performed alongside a before-and-after study, with a convenience control group measured only afterward, and a 9-month follow-up. Control group patients received regular care and were measured before implementation of the TTCM. Intervention group patients received the TTCM and were measured after its implementation. The primary outcome was generic health-related quality of life (HR-QOL). Secondary outcomes included disease-specific HR-QOL, pain, functional status, and perceived recovery.

Results

Eighty-three trauma patients were included in the intervention group and fifty-seven in the control group. Total societal costs were lower in the intervention group than in the control group, but not statistically significantly so (EUR-267; 95 percent confidence interval [CI], EUR-4,175–3011). At 9 months, there was no statistically significant between-group differences in generic HR-QOL (0.05;95 percent CI, −0.02–0.12) and perceived recovery (0.09;95 percent CI, −0.09–0.28). However, mean between-group differences were statistically significantly in favor of the intervention group for disease-specific HR-QOL (−8.2;95 percent CI, −15.0–−1.4), pain (−0.84;95CI, −1.42–−0.26), and functional status (−20.1;95 percent CI, −29.6–−10.7). Cost-effectiveness acceptability curves indicated that if decision makers are not willing to pay anything per unit of effect gained, the TTCM has a 0.54–0.58 probability of being cost-effective compared with regular care. For all outcomes, this probability increased with increasing values of willingness-to-pay.

Conclusions

The TTCM may be cost-effective compared with regular care, depending on the decision-makers willingness to pay and the probability of cost-effectiveness that they perceive as acceptable.

Keywords

Trauma rehabilitationHR-QOLCost-effectivenessEconomic evaluationHR-QOL
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 4 , 2019 , pp. 307 - 316
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Ethics approval and consent to participate: The medical ethics committee of the VUmc assessed the present study, and decided the Dutch Medical Research Involving Human Subjects Act (WMO) was not applicable (registered under number 2013.454). All participants gave informed consent. The trial is registered at the Dutch Trial Register (NTR5474). Authors’ contributions: S.H.W. has been involved in the development of the TTCM, the design of the study, the implementation of the TTCM, the data collection, the data analysis and writing the manuscript. JMD was closely involved in the design of the study, was responsible for the economic evaluation and involved in writing the manuscript. EG and RJH were substantially involved in development of the TTCM and negotiated a model for reimbursement with hospital managers, policy makers and insurers. F.W.B., V.G., and R.W.O. were involved in the overall design of the study and were critically reading the manuscript for important intellectual content. All authors read and approved the final manuscript. Acknowledgements: We thank all trauma patients who participated in the study. Furthermore, we thank Frank Duijff and Sander Assendelft from FysioRoadmap for their ongoing support and technical assistance during the project. Finally we thank Milou Rossenaar for her help with the cost-effectiveness analyses as a part of her graduation thesis. Financial support: This project is partly funded by “Zilveren Kruis Health Insurer” (grant number Z516).

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