A Decision Tree Cost Analysis of Intracranial Bleed Detection Using a Near-Infrared Device Across Various Healthcare...

Traumatic brain injury (TBI), mainly caused by road traffic accidents, is a serious global public health concern. Computed tomography (CT) is the best way to detect intracranial haemorrhage (ICH), but it is not always feasible because it is hard to access, exposes people to radiation, and is expensive, especially in low- and middle-income countries. Portable near-infrared spectroscopy (NIRS) devices offer a non-invasive, point-of-care option for early detection of ICH. The objectives of this study were to estimate the cost per case detected for patients with mild-to-moderate TBI, to estimate incremental cost and to perform a budget impact analysis to assess the financial feasibility of implementing this technology. This study employed a decision tree model from a health system perspective to calculate the cost per detected case and the incremental cost of NIRS across three tiers of care: ambulances, community health centres (CHCs), and tertiary hospitals. The cost per mild-to-moderate TBI case found was Rs. 2177.90 in ambulances, Rs. 748.09 in CHCs, and Rs. 628.14 in tertiary hospitals. The extra cost per patient was Rs. 984.15, Rs. 360.90, and Rs. 289.78, respectively. At the system level, NIRS raised the total costs for 264 ambulance patients from Rs. 37.71 lakh to Rs. 40.31 lakh and for 858 CHC patients from Rs. 115.64 lakh to Rs. 118.73 lakh. National extrapolation indicates a first-year budgetary impact of approximately Rs. 442 crores for ambulances and Rs. 187 crores for CHCs. These results support the strategic, phased implementation of NIRS to use resources better and improve early diagnosis of TBI.