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Cost Effectiveness of Pediatric Blunt Cerebrovascular Injury Screening: A Decision Tree Analysis
Alexandra L Campbell1, Dennis Xuan2, Prashanth Balaraman1
1Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA.
Insights
Identifying the most cost-effective screening for pediatric blunt cerebrovascular injury (pBCVI) is crucial. The optimal strategy depends on local pBCVI incidence rates, with no single approach fitting all centers.
Area of Science:
- Pediatric Traumatology
- Vascular Surgery
- Health Economics
Background:
- Early identification of pediatric blunt cerebrovascular injury (pBCVI) is critical for stroke prevention in children under 18.
- Current screening strategies for pBCVI lack a standardized, cost-effective approach, leading to practice variability.
- The Memphis criteria (MC) were hypothesized as the most cost-effective due to their high sensitivity.
Purpose of the Study:
- To identify the most cost-effective screening strategy for pediatric blunt cerebrovascular injury (pBCVI).
- To compare the cost-effectiveness of various screening protocols including no screening, Denver criteria, Expanded Denver criteria, Memphis criteria, McGovern criteria, Utah criteria, and universal screening.
Main Methods:
- A Decision Tree analysis model was employed to evaluate seven distinct pBCVI screening strategies.
- The model incorporated a range of pBCVI incidences (0.2-2.7%) and analyzed costs and quality-adjusted life years (QALYs) over a 5-year period.
- Detected pBCVI cases were assumed to receive antithrombotic therapy to mitigate stroke and mortality risks.
Main Results:
- At low pBCVI incidences, the Utah criteria (UC) demonstrated the most cost-savings per QALY compared to no screening.
- At high pBCVI incidences, the Memphis criteria (MC) yielded the highest cost-savings compared to the McGovern criteria (MG).
- Sensitivity analyses confirmed that the cost-effectiveness of screening strategies is highly dependent on the specific pBCVI incidence rate.
Conclusions:
- The optimal cost-effective screening strategy for pBCVI is not universal and is contingent upon accurate local incidence rates.
- Pediatric trauma centers should customize their pBCVI screening protocols based on regional incidence data to improve efficiency and patient outcomes.
- Further research is necessary to refine pBCVI incidence rates in pediatric populations to better inform screening decisions.
Background:
Early identification of blunt cerebrovascular injury in the pediatric (<18 years) population (pBVCI) is essential to minimize stroke. However, the most cost-effective screening strategy for pBCVI is unknown, and there is high variability in practice nationwide. We sought to identify the most cost-effective screening strategy for identifying pBCVI and hypothesized that Memphis criteria (MC) would be the most cost-effective due to its high sensitivity.
Study Design:
A Decision Tree analysis model was used to compare the following BCVI screening strategies in peds: (1) no screening (NS); (2) Denver criteria (DC); (3) Expanded Denver criteria (eDC); (4) MC; (5) McGovern criteria (MG); (6) Utah criteria (UC); and (7) universal screening (US). The model considered a range of pBCVI incidences (0.2-2.7 %) and analyzed costs and utilities over a 5-year time horizon. pBCVI cases detected by screening modalities were assumed to be given antithrombotic therapy which mitigates the risk of stroke and mortality.
Results:
Our analysis revealed that at low pBCVI incidences, UC was most cost-saving per additional quality-adjusted life year (QALY) compared to NS, while MC yielded the highest savings at high incidences compared to MG. Sensitivity analyses indicated the cost-effectiveness of screening strategies varied significantly with pBCVI incidence.
Conclusions:
The cost-effectiveness of pBCVI screening is contingent upon accurate incidence rates, with no one-size-fits-all solution. Pediatric trauma centers should tailor their screening strategies to local pBCVI rates to enhance cost-efficiency and patient outcomes. Further research is needed to better define BCVI incidence rates in children to inform these decisions.
Type Of Study:
Clinical Research Paper.
