The Transmural Trauma Care Model (TTCM) is cost-effective, as evaluated in a multicenter trial

Julia Ratter, Edwin Geleijn, Raymond Ostelo, Hanneke van Dongen, Suzanne Wiertsema, Roxanne Boersma, Anouk Pijnappel
Purpose:

This study investigates the cost-effectiveness of the TTCM, a multidisciplinary transmural rehabilitation model for trauma patients, compared with usual care in ten Dutch hospitals.

Methods:

This economic evaluation was conducted alongside a 9-month controlled-before-and-after trial. Patients from eleven Dutch trauma centers were followed prospectively. First, the control group was followed and received usual care. After the TTCM was implemented, the intervention group was followed. Outcome measures included QALYs and functional status. Costs were measured from a societal perspective. Missing data were imputed, and Targeted Maximum Likelihood Estimation was used for data analysis. Sensitivity analyses were conducted to assess the robustness of the results.

Results:

Of the 528 patients, 322 received usual care and 206 received the TTCM. After nine months, the intervention group showed more favorable results in terms of QALYs (0.013, 95%CI -0.006;0.032) and functional status (3.1, 95%CI -0.2;6.5). The average cost of the TTCM was €120 per patient. Except for presenteeism costs, all other disaggregated cost differences were in favor of the intervention group. The probability of cost-effectiveness for QALY was 85% if decision-makers were not willing to pay and increased to 89% at a willingness to pay of €20,000/QALY gained. For functional status, similar probabilities of cost-effectiveness were found for reasonable values of willingness to pay. Sensitivity analyses supported these findings.

Conclusion(s):

Results suggest that TTCM has a high likelihood of being cost-effective compared to usual care among trauma patients for QALYs and functional status. This makes the TTCM a promising approach for post-clinical trauma rehabilitation.

Implications:

TTCM shows promising cost-effectiveness and favorable patient outcomes when compared to usual care and is therefore an improvement in current trauma rehabilitation. Findings from this multicenter study validate a broad implementation of the TTCM, which provides good “value for money”. When implemented broadly, TTCM acts as an appropriate legal and financial framework for this complex transmural healthcare intervention.

Funding acknowledgements:
This study is funded by ZonMw (grant number 80-85200-98-91009).
Keywords:
transmural care
trauma
network care
Primary topic:
Musculoskeletal
Second topic:
Research methodology, knowledge translation and implementation science
Third topic:
Education: continuing professional development
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The medical ethics committee of the Amsterdam University Medical Centers assessed the present study (registered under number A2019.459 (2019.419)).
Provide the ethics approval number:
A2019.459 (2019.419)
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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