Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review

Blanchard Conombo, Jason R. Guertin, Pier Alexandre Tardif, Marc Aurèle Gagnon, Cécile Duval, Patrick Archambault, Simon Berthelot, François Lauzier, Alexis F. Turgeon, Henry T. Stelfox, Michaël Chassé, Jeffrey S. Hoch, Belinda Gabbe, Howard Champion, Fiona Lecky, Peter Cameron, Lynne Moore

Research output: Contribution to journalReview articlepeer-review

Abstract

Objectives: Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. Methods: Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). Results: Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars −467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. Conclusions: This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.

Original languageEnglish (US)
JournalValue in Health
DOIs
StateAccepted/In press - 2021

Keywords

  • cost-benefit analysis
  • injury
  • low-value clinical practices
  • value-based care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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