Introduction: Major trauma is a leading cause of death and disability in young adults, especially from massive noncompressible
torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion
is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of
resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage
without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim
of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major
traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service.
Methods: A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published
literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ5D
index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data
and supplemented from further literature. A cost–utility analysis was then conducted.
Results: A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for
RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental costeffectiveness
ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental
cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay
threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to
RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%.
Conclusion: Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical
experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the
emergency context.