Pyne, S;
Barton, G;
Turner, D;
Mee, H;
Gregson, BA;
Kolias, AG;
Turner, C;
Adams, H;
Mohan, M;
Uff, C;
et al.
Pyne, S; Barton, G; Turner, D; Mee, H; Gregson, BA; Kolias, AG; Turner, C; Adams, H; Mohan, M; Uff, C; Hasan, S; Wilson, M; Bulters, DO; Zolnourian, A; McMahon, C; Stovell, MG; Al-Tamimi, Y; Thomson, S; Viaroli, E; Belli, A; King, A; Helmy, AE; Timofeev, I; Menon, D; Hutchinson, PJ
(2024)
Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma.
BMJ Open, 14 (6).
e085084-e085084.
ISSN 2044-6055
https://doi.org/10.1136/bmjopen-2024-085084
SGUL Authors: Papadopoulos, Marios
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Abstract
Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. Setting UK secondary care. Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). Trial registration number ISRCTN87370545.
Item Type: | Article | |||||||||
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Additional Information: | © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. | |||||||||
Keywords: | 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences | |||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Neuroscience & Cell Biology Research Institute Academic Structure > Neuroscience & Cell Biology Research Institute > Neuromodulation & Motor Control |
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Journal or Publication Title: | BMJ Open | |||||||||
ISSN: | 2044-6055 | |||||||||
Language: | en | |||||||||
Publisher License: | Creative Commons: Attribution 4.0 | |||||||||
Projects: |
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URI: | https://openaccess.sgul.ac.uk/id/eprint/116948 | |||||||||
Publisher's version: | https://doi.org/10.1136/bmjopen-2024-085084 |
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