Long-term survival and return on investment after nonneurologic injury: Implications for the elderly trauma patient

Background: As the population of the United States ages and as the healthcare system undergoes significant change, cost effectiveness of care will become more important, particularly for older injured patients. The purpose of this study was to evaluate the cost per 2-year survivor stratified by age after moderate- to severe-nonneurologic injury. Methods: The trauma registry from a Level I trauma center was queried for adults (older than 18 years), discharged alive after blunt injury (Injury Severity Score >15), without significant neurologic injury, and with hospital charge data. Survival was determined using the Social Security Death Master File. Patients were stratified by age. Hospital costs were calculated by multiplying hospital charge by the cost to charge ratio. Results: One thousand nine hundred fourteen patients made up the study population. Mean hospital cost per patient was $10,021. Mean cost per 2-year survivor was $10,328. Overall 2-year survival was 97%. (*p < 0.05 vs. youngest). When broken down by age group, there were no significant differences in hospital costs. However, 2-year survival was significantly less in those who were 55.1 years to 75 years old and those older than 75 years, when compared with those aged 18 years to 25 years. Thus, median cost per 2-year survivor was highest in those older than 75 years ($8,911). Conclusion: Although costs are similar by age at time of discharge, cost per 2-year survivor increases as age increases. However, cost per 2-year survivor does not exceed current cost-utility thresholds for any age group. Any future healthcare financing reforms should include aggressive funding for injury prevention efforts aimed at vulnerable populations instead of rationing care once an injury occurs.