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NEUROLOGICAL DISEASES - ORIGINAL ARTICLES
Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 234-241

Cost-Effectiveness Analysis of Head Computed Tomography in Children with Mild Traumatic Brain Injury: A Retrospective Study


Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Correspondence Address:
Thara Tunthanathip
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_8_21

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Background: Head computed tomography (CT) is used as a diagnostic tool for intracranial injury following traumatic brain injury (TBI). However, the long-term effects of radiation exposure should be of concern in children. This study compared the cost-effectiveness of the early head CT (ECT) strategy with that of initial conservative treatment with parent education of the nonearly CT (NECT) in pediatric TBI with a Glasgow Coma Scale (GCS) score of 15. Methods: A retrospective study was conducted with TBI children with a GCS of 15, who were treated at an emergency department (ED). The costs and outcomes of the children were recorded. The authors used a decision tree model (Plant-A-Tree, International Decision Support Initiative, United Kingdom) to compare the cost-effectiveness analysis of two strategies. The incremental cost-effectiveness ratio (ICER) was also calculated. Results: For the ECT group, the rate of the positive results following head CT was 17.6%, and the common intracranial injuries were epidural hematoma, skull fracture, and subdural hematoma in 11.5%, 9.8%, and 6.6%, respectively. The children in the ECT group who underwent surgery were 3.2%. For the NECT group, revisions were observed in 5.3%, and all patients with revision underwent CT. Therefore, the frontal contusion was observed in 10% following CT, and none underwent surgery in the NECT group. From a healthcare provider’s perspective, the expected cost of the ECT group was US $597.49, whereas the expected cost of the NECT group that included overall costs at ED was US $115.27. The expected outcome of the ECT group was less than the NECT group that caused the base-case ICER to be negative (−US $30,715.28 per outcome gained). A sensitivity analysis revealed that an early CT strategy became a dominant strategy that needed a low revision rate but a high rate of positive findings after head CT. Conclusion: The initial conservative treatment was the dominant strategy. This strategy was safe and effective and could diminish the unnecessary exposure to radiation in children.


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