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Published on: April 13, 2013
Cost-effectiveness of head computed tomography in infants with possible inflicted traumatic brain injury
Kristine A Campbell1, Rachel P Berger, Lorraine Ettaro
1Division of Safe and Healthy Families, Department of Pediatrics, University of Utah, 295 Chipeta Way, Box 581289, Salt Lake City, UT 84158, USA. kristine.campbell@hsc.utah.edu
Insights
Head computed tomography (CT) screening for infants with suspected inflicted traumatic brain injury is cost-effective from a medical payer perspective, potentially saving costs and improving outcomes. Societal costs, however, are higher due to child protection expenses.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Health Economics
Background:
- Early diagnosis of inflicted traumatic brain injury (iTBI) is crucial to reduce morbidity and mortality.
- Infants with unexplained scalp bruising or a history of apparent life-threatening events are at risk for iTBI.
- Head computed tomography (CT) is a key diagnostic tool in evaluating potential iTBI.
Purpose of the Study:
- To estimate the cost-effectiveness of a head CT policy for diagnosing iTBI in selected infants presenting to the emergency department.
- To compare the costs and outcomes of head CT versus no head CT in high-risk infants.
- To inform clinical decision-making regarding iTBI screening in infants.
Main Methods:
- Markov models were constructed to simulate health states including no iTBI, misdiagnosed iTBI, mild iTBI, and severe/fatal iTBI.
- Literature review was used to estimate iTBI incidence, probabilities of outcomes, and associated medical and societal costs.
- Sensitivity and Monte Carlo analyses were performed to assess the robustness of the findings across a range of parameters.
Main Results:
- From a medical payer perspective, head CT screening for iTBI in infants with unexplained scalp bruising was found to be cost-saving.
- Sensitivity analyses indicated that head CT costs were less than $50,000 per severe or fatal iTBI averted when iTBI prevalence exceeded 3%.
- Societal costs were higher when including child protection expenses, making the head CT policy appear less cost-effective from this viewpoint.
Conclusions:
- Head CT screening for iTBI in infants can be cost-effective and improve patient outcomes from a medical payer standpoint.
- The higher societal cost is attributed to the significant short-term expenses associated with child protection services.
- The study supports a low medical threshold for CT screening in at-risk infants and emphasizes the need for further research into long-term child abuse outcomes.
Objective:
Early diagnosis of inflicted traumatic brain injury may reduce morbidity and mortality associated with repeated inflicted traumatic brain injuries. We undertook this study to estimate the cost-effectiveness of a policy of head computed tomography (CT) for inflicted traumatic brain injury in selected infants seen in an emergency department.
Methods:
We constructed Markov models to compare a policy of CT to no CT in an asymptomatic 5-week-old infant with either (1) unexplained scalp bruising or (2) a history of an apparent life-threatening event. Health states modeled were no inflicted traumatic brain injury, misdiagnosed inflicted traumatic brain injury, mild inflicted traumatic brain injury (diagnosed or undiagnosed), and severe and fatal inflicted traumatic brain injury. Infants with undiagnosed inflicted traumatic brain injury were at increased risk of repeat inflicted traumatic brain injury. We used available literature to estimate probabilities, costs, and outcomes. The models terminated at death or at 52 weeks of age. Outcomes considered were severe and fatal inflicted traumatic brain injury cases averted through early detection of mild inflicted traumatic brain injury.
Data Sources:
We conducted a literature review for estimates of inflicted traumatic brain injury incidence, outcome probabilities, and medical and societal costs. Wide ranges were set for sensitivity and Monte Carlo analyses.
Results:
From a medical payer perspective, head CT for inflicted traumatic brain injury in infants with unexplained scalp bruising saved money. Sensitivity analysis demonstrated costs less than $50,000 per severe or fatal inflicted traumatic brain injury averted in scenarios in which initial inflicted traumatic brain injury prevalence was >3%. From a societal perspective, costs of child protection made head CT for inflicted traumatic brain injury more expensive.
Conclusions:
From a medical payer perspective, our models demonstrate that CT for inflicted traumatic brain injury can be cost-effective and improve outcomes. The finding of higher societal cost reflects the substantial short-term costs of child protection. Our study supports a low medical threshold for CT screening and highlights the need for improved understanding of long-term costs and outcomes of child abuse.
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