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Updated: Jul 9, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Measuring the cost-effectiveness of technologic change in the treatment of pediatric traumatic brain injury
John M Tilford1, Mary E Aitken, Allen C Goodman
1Center for Applied Research and Evaluation, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA. tilfordmickj@uams.edu
Insights
Aggressive treatment for pediatric traumatic brain injuries (TBI) may improve survival. Cost-effectiveness analysis shows that TBI interventions are favorable if survivors live more than five years.
Area of Science:
- Pediatric critical care
- Health economics
- Neurotrauma
Background:
- Management of pediatric traumatic brain injuries (TBI) varies significantly across centers.
- Aggressive TBI treatment may enhance survival rates but lacks clear cost-effectiveness justification.
Purpose of the Study:
- To evaluate the cost-effectiveness of technological advancements in treating pediatric TBI.
- To determine the cost per quality-adjusted life year (QALY) gained from these interventions.
Main Methods:
- Utilized national hospital administrative data for children under 21 with TBI requiring mechanical ventilation.
- Calculated the incremental cost-effectiveness ratio (ICER) per QALY gained.
- Incorporated survival data, life expectancies (5-30 years), and preference scores (~0.5).
Main Results:
- The estimated ICER ranged from $19,000 to $109,000 per QALY gained.
- Including rehabilitation costs increased the ICER to $57,000-$244,000 per QALY.
- Sensitivity analysis highlighted life years gained as a critical factor.
Conclusions:
- The cost-effectiveness of pediatric TBI interventions appears favorable if survivors live beyond five years.
- Technological changes in TBI treatment offer a potentially justifiable approach when considering long-term outcomes.
Abstract:
Substantial variation exists with respect to the management of traumatic brain injuries (TBI) in children. Centers that practice aggressive treatment of TBI may improve survival, but it is not clear that the outcomes can be justified using cost-effectiveness criteria. This study illustrates the use of cost-effectiveness analysis to assess interventions for improving outcomes in children by assessing the cost per quality-adjusted life year (QALY) gained from technological change in the treatment of TBI. Cost and survival data associated with technological change in the treatment of pediatric TBI was based on nationally representative hospital administrative data for all children <21 years with a TBI who required endotracheal intubation or mechanical ventilation. With QALYs of pediatric TBI survivors based on life expectancies ranging between 5 and 30 years and on an estimated preference score of approximately 0.5, the estimated incremental cost-effectiveness ratio ranges between $19,000 and $109,000 per QALY gained. Adding estimated rehabilitation costs increases the cost-effectiveness ratio to between $57,000 and $244,000 per QALY. Sensitivity analysis indicates that estimates of life years gained are critical to the estimated ratio. If TBI survivors live more than 5 years, then the estimated cost-effectiveness ratio seems favorable.
