Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality

Alali, Aziz S.; Burton, Kirsteen R.; Fowler, Robert; Naimark, David; Scales, Damon C.; Mainprize, Todd G.; Nathens, Avery B.

doi:10.1016/j.jval.2015.04.012

Cited by 45 publications

(39 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…262 However, a recent systematic review showed that evidence of economic benefit was available for only a minority of interventions for TBI, and much of the existing evidence was of poor quality. 279 Panel 8 summarizes interventions for which cost-effectiveness data are available.…”

Section: Cost-effectiveness Of Systems-level Management Strategiesmentioning

confidence: 99%

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Maas¹,

Menon²,

Adelson³

et al. 2017

The Lancet Neurology

1,769

1,261

View full text Add to dashboard Cite

A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world's population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders—policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI.Additional co-authors: Endre Czeiter, Marek Czosnyka, Ramon Diaz-Arrastia, Jens P Dreier, Ann-Christine Duhaime, Ari Ercole, Thomas A van Essen, Valery L Feigin, Guoyi Gao, Joseph Giacino, Laura E Gonzalez-Lara, Russell L Gruen, Deepak Gupta, Jed A Hartings, Sean Hill, Ji-yao Jiang, Naomi Ketharanathan, Erwin J O Kompanje, Linda Lanyon, Steven Laureys, Fiona Lecky, Harvey Levin, Hester F Lingsma, Marc Maegele, Marek Majdan, Geoffrey Manley, Jill Marsteller, Luciana Mascia, Charles McFadyen, Stefania Mondello, Virginia Newcombe, Aarno Palotie, Paul M Parizel, Wilco Peul, James Piercy, Suzanne Polinder, Louis Puybasset, Todd E Rasmussen, Rolf Rossaint, Peter Smielewski, Jeannette Söderberg, Simon J Stanworth, Murray B Stein, Nicole von Steinbüchel, William Stewart, Ewout W Steyerberg, Nino Stocchetti, Anneliese Synnot, Braden Te Ao, Olli Tenovuo, Alice Theadom, Dick Tibboel, Walter Videtta, Kevin K W Wang, W Huw Williams, Kristine Yaffe for the InTBIR Participants and Investigator

show abstract

Section: Cost-effectiveness Of Systems-level Management Strategiesmentioning

confidence: 99%

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Maas¹,

Menon²,

Adelson³

et al. 2017

The Lancet Neurology

1,769

1,261

View full text Add to dashboard Cite

show abstract

“…There is an increasing pressure from governments, insurance companies, and healthcare providers to control healthcare costs [ 30 ]. The demand for high-quality evidence regarding the cost-effectiveness of treatments is also seen in TBI, where it lacks and where expensive life-saving surgical treatments can also result in a poor HRQoL [ 2 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Functional and patient-reported outcome versus in-hospital costs after traumatic acute subdural hematoma (t-ASDH): a neurosurgical paradox?

et al. 2019

View full text Add to dashboard Cite

Background The decision whether to operate or not in patients with a traumatic acute subdural hematoma (t-ASDH) can, in many cases, be a neurosurgical dilemma. There is a general conception that operating on severe cases leads to the survival of severely disabled patients and is associated with relatively high medical costs. There is however little information on the quality of life of patients after operation for t-ASDH, let alone on the cost-effectiveness. Methods This study retrospectively investigated patient outcome and in-hospital costs for 108 consecutive patients with a t-ASDH. Patient outcome was assessed using the Glasgow Outcome Score (GOS) and the Traumatic Brain Injury (TBI)–specific QOLIBRI questionnaire. The in-hospital costs were calculated using the Dutch guidelines for costs calculation. Results Out of 108 patients, 40 were classified as having sustained a mild (Glasgow Coma Scale (GCS) 13–15), 19 a moderate (GCS 9–12), and 49 a severe (GCS 3–8) TBI. As expected, mortality rates increased with higher TBI severity (23%, 47%, and 61% respectively), whereas the chance for favorable outcome (GOS 4–5) decreased (72%, 47%, and 29%). Interestingly, the mean QOLIBRI scores for survivors were quite similar between the TBI severity groups (61, 61, and 64). Healthcare consumption and in-hospital costs increased with TBI severity. In-hospital costs were relatively high (€24,980), especially after emergency surgery (€28,670) and when additional ICP monitoring was used (€36,580). Conclusions Although this study confirms that outcome is often “unfavorable” after t-ASDH, it also shows that “favorable” outcome can be achieved, even in the most severely injured patients. In-hospital treatment costs were substantial and mainly related to TBI severity, with admission and surgery as main cost drivers. These results serve as a basis for necessary future research focusing on the value-based cost-effectiveness of surgical treatment of patients with a t-ASDH. Electronic supplementary material The online version of this article (10.1007/s00701-019-03878-5) contains supplementary material, which is available to authorized users.

show abstract

“…Keywords Traumatic brain injury Á Ventilator-associated pneumonia Á Risk factors Á Incidence Á Cerebral oxygenation Á PbtO 2 Á Outcome Background Traumatic brain injury (TBI) is a leading cause of premature death and disability, with an annual incidence estimated at 500/100,000 in the USA and Europe [1][2][3]. TBIs are considered severe when, after initial resuscitation, they score B8 on the Glasgow Coma Scale (GCS) [4].…”

mentioning

confidence: 99%

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

et al. 2017

View full text Add to dashboard Cite

EOVAP is frequent after a severe TBI (overall rate: 61%), with therapeutic hypothermia, severe thoracic lesion, and gastric aspiration as main risk factors. EOVAP had a negative impact on cerebral oxygenation measured by PbtO and was independently associated with unfavorable outcome at 1-year follow-up. This suggests that all precautions available should be taken to prevent EOVAP in this population.

show abstract

Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality

Abstract: 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.

Cited by 45 publications

References 55 publications

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Functional and patient-reported outcome versus in-hospital costs after traumatic acute subdural hematoma (t-ASDH): a neurosurgical paradox?

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

Contact Info

Product

Resources

About