Minor head injury: CT-based strategies for management--a cost-effectiveness analysis
Purpose: To compare the cost-effectiveness of using selective computed tomographic (CT) strategies with that of performing CT in all patients with minor head injury (MHI). Materials and methods: The internal review board approved the study; written informed consent was obtained from all interviewed patients. Five strategies were evaluated, with CT performed in all patients with MHI; selectively according to the New Orleans criteria (NOC), Canadian CT head rule (CCHR), or CT in head injury patients (CHIP) rule; or in no patients. A decision tree was used to analyze short-term costs and effectiveness, and a Markov model was used to analyze long-term costs and effectiveness. n-Way and probabilistic sensitivity analyses and value-of-information (VOI) analysis were performed. Data from the multicenter CHIP Study involving 3181 patients with MHI were used. Outcome measures were first-year and lifetime costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. Results: Study results showed that performing CT selectively according to the CCHR or the CHIP rule could lead to substantial U.S. cost savings ($120 million and $71 million, respectively), and the CCHR was the most cost-effective at reference-case analysis. When the prediction rule had lower than 97% sensitivity for the identification of patients who required neurosurgery, performing CT in all patients was cost-effective. The CHIP rule was most likely to be cost-effective. At VOI analysis, the expected value of perfect information was $7 billion, mainly because of uncertainty about long-term functional outcomes. Conclusion: Selecting patients with MHI for CT renders cost savings and may be cost-effective, provided the sensitivity for the identification of patients who require neurosurgery is extremely high. Uncertainty regarding long-term functional outcomes after MHI justifies the routine use of CT in all patients with these injuries.
|Keywords||Cost-Benefit Analysis/*economics, Craniocerebral Trauma/*economics/*radiography, Decision Trees, Female, Glasgow Coma Scale, Humans, Interviews as Topic, Male, Markov Chains, Monte Carlo Method, Quality-Adjusted Life Years, Retrospective Studies, Sensitivity and Specificity, Survival Analysis, Tomography, X-Ray Computed/*economics, minor head injury|
|Persistent URL||dx.doi.org/10.1148/radiol.2541081672, hdl.handle.net/1765/21238|
Smits, M, Hofman, P.A.M, Rijssel, D.A, Twijnstra, A, Tanghe, H.L.J, Hunink, M.G.M, … Kool, D.R. (2010). Minor head injury: CT-based strategies for management--a cost-effectiveness analysis. Radiology, 254(2), 532–540. doi:10.1148/radiol.2541081672