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

Aziz S Alali; Kirsteen Burton; Robert A Fowler; David M J Naimark; Damon C Scales; Todd G Mainprize; Avery B Nathens

doi:10.1016/j.jval.2015.04.012

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

Value Health. 2015 Jul;18(5):721-34. doi: 10.1016/j.jval.2015.04.012. Epub 2015 Jul 26.

Authors

Aziz S Alali¹, Kirsteen Burton², Robert A Fowler³, David M J Naimark⁴, Damon C Scales³, Todd G Mainprize⁵, Avery B Nathens⁶

Affiliations

¹ Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada. Electronic address: aziz.alali@mail.utoronto.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
³ Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
⁶ Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.

PMID: 26297101
DOI: 10.1016/j.jval.2015.04.012

Abstract

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 of TBI.

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.

Keywords: cost utility; cost-benefit analysis; cost-effectiveness; economic evaluation; systematic review; traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Age Factors
Brain Injuries* / diagnosis
Brain Injuries* / economics
Brain Injuries* / therapy
Cost Savings
Cost-Benefit Analysis
Decision Support Techniques
Diagnostic Techniques and Procedures / economics*
Diagnostic Techniques and Procedures / standards
Evidence-Based Medicine / economics*
Health Care Costs*
Humans
Models, Economic
Predictive Value of Tests
Tomography, X-Ray Computed
Treatment Outcome

Grants and funding

Canadian Institutes of Health Research/Canada