Research Reports - Economic evaluations in the diagnosis and management of traumatic brain injury
Value Health. 2015 Jul;18(5):721-34
Alali AS(1), Burton K(2), Fowler RA(3), Naimark DM(4), Scales DC(3), Mainprize
TG(5), Nathens AB(6)
BACKGROUND: Economic evaluations provide a unique opportunity to identify the
optimal strategies for the diagnosis and management of traumatic brain injury
(TBI), for which uncertainty is common and the economic burden is substantial.
OBJECTIVE: The objective of this study was to systematically review and examine
the quality of contemporary economic evaluations in the diagnosis and management
METHODS: Two reviewers independently searched MEDLINE, EMBASE, Cochrane Central
Register of Controlled Trials, NHS Economic Evaluation Database, Health
Technology Assessment Database, EconLit, and the Tufts CEA Registry for
comparative economic evaluations published from 2000 onward (last updated on
August 30, 2013). Data on methods, results, and quality were abstracted in
duplicate. The results were summarized quantitatively and qualitatively.
RESULTS: Of 3539 citations, 24 economic evaluations met our inclusion criteria.
Nine were cost-utility, five were cost-effectiveness, three were
cost-minimization, and seven were cost-consequences analyses. Only six studies
were of high quality. Current evidence from high-quality studies suggests the
economic attractiveness of the following strategies: a low medical threshold for
computed tomography (CT) scanning of asymptomatic infants with possible inflicted
TBI, selective CT scanning of adults with mild TBI as per the Canadian CT Head
Rule, management of severe TBI according to the Brain Trauma Foundation
guidelines, management of TBI in dedicated neurocritical care units, and early
transfer of patients with TBI with nonsurgical lesions to neuroscience centers.
CONCLUSIONS: Threshold-guided CT scanning, adherence to Brain Trauma Foundation
guidelines, and care for patients with TBI, including those with nonsurgical
lesions, in specialized settings appear to be economically attractive strategies.