The cost-effectiveness of diagnostic management strategies for children with minor head injury
The cost-effectiveness of diagnostic management strategies for children with minor head injury
复制标题
DOI：
10.1136/archdischild-2012-302820
复制
发表时间：
2013-12-01
影响因子：
5.2
通讯作者：
Pickering, A.
中科院分区：
文献类型：
--
作者：
Holmes, M. W.;Goodacre, S.;Pickering, A.
目的评价儿童轻型颅脑损伤诊断性治疗策略的成本-效果，确定最优治疗策略。方法建立概率决策分析模型，估算6种可能的轻型颅脑损伤治疗策略的成本和质量调整生命年(QALY)，其中包括理论上的零选择策略，即所有患者不经调查就出院。结果最优策略是基于儿童颅脑损伤预测重要临床事件(CHALICE)规则，尽管每种策略的成本和结果大致相似。结论自由使用基于高灵敏度决策规则的CT扫描不仅有效，而且节省成本，其中CHARICE规则是最优策略，但结果存在一定的不确定性。当比较所有选择性CT策略时，成本和QALY的增量变化非常小。与CT扫描的成本相比，护理因延迟治疗而恶化的脑损伤患者的估计成本非常高。这一分析建议，所有收治轻微头部损伤儿童的医院都应该不受限制地接受CT扫描，以便与循证指南一起使用。
Aim To estimate the cost-effectiveness of diagnostic management strategies for children with minor head injury and identify an optimal strategy.Methods A probabilistic decision analysis model was developed to estimate the costs and quality-adjusted life years (QALYs) accrued by each of six potential management strategies for minor head injury, including a theoretical 'zero option' strategy of discharging all patients home without investigation. The model took a lifetime horizon and the perspective of the National Health Service.Results The optimal strategy was based on the Children's Head injury Algorithm for the prediction of Important Clinical Events (CHALICE) rule, although the costs and outcomes associated with each strategy were broadly similar.Conclusions Liberal use of CT scanning based on a high sensitivity decision rule is not only effective but also cost saving, with the CHALICE rule being the optimal strategy, although there is some uncertainty in the results. Incremental changes in the costs and QALYs are very small when all selective CT strategies are compared. The estimated cost of caring for patients with brain injury worsened by delayed treatment is very high compared with the cost of CT scanning. This analysis suggests that all hospitals receiving children with minor head injury should have unrestricted access to CT scanning for use in conjunction with evidence-based guidelines.