Child health-related quality of life following neurocritical care for traumatic brain injury: an analysis of preference-weighted outcomes

Tilford, John M.; Aitken, Mary E.; Goodman, Allen C.; Fiser, Debra H.; Killingsworth, Jeffrey B.; Green, Jerril W.; Adelson, P. David

doi:10.1007/s12028-007-0037-5

Cited by 13 publications

(10 citation statements)

References 45 publications

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“…An initial description of these outcomes and construct validity has been reported elsewhere. 9 Scores ranged from 0.09 to 1.00 at 3 and 6 months after discharge from the ICU, but mean scores increased from 0.51 to 0.58 between the two periods. Scores were correlated with clinical characteristics, injury severity, and other health-related quality of life measures.…”

Section: Discussionmentioning

confidence: 95%

“…17 This study highlights this recommendation as we use preference scores developed from our prior study. 9 Preference-weighted health outcomes in children who survived a TBI hospitalization were reported from a cohort of children admitted to 10 pediatric intensive care units (PICUs) that were located nationally. Subject inclusion criteria followed the inclusion criteria for estimating survival probabilities and required that the child be less than 18 years of age and admitted to the PICU with a Centers for Disease Control and Prevention-defined TBI 13 that required either endotracheal intubation or mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…9 An analysis of the correlation in preference scores with clinical data obtained from the ICU admission suggested that such scores have construct validity. In theory, the scores can be used to consider acceptable ranges for conducting CEA as presented in this study.…”

Section: Preference-weighted Health Outcomesmentioning

confidence: 99%

“…8 Recently, Tilford et al reported TBI outcomes using the quality of well-being (QWB) scale. 9 Given the lack of studies describing preference-weighted outcomes in children (or adults) after injuries, it is not surprising that only one economic evaluation provided information on traumatic injuries that followed the USPHS guidelines. Stein et al examined indications for cranial computed tomography scanning after mild TBI using CEA.…”

mentioning

confidence: 99%

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Measuring the Cost-Effectiveness of Technologic Change in the Treatment of Pediatric Traumatic Brain Injury

Tilford

Aitken

Goodman

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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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 costeffectiveness criteria. This study illustrates the use of cost-effectiveness analysis to assess interventions for improving outcomes in children by assessing the cost per qualityadjusted 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 costeffectiveness 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.J Trauma. 2007;63:S113-S120. Cost-effectiveness analysis (CEA) can be used to evaluate interventions for improving health outcomes in injured children in relation to the costs of the intervention. For example, a trauma system change (intervention) that ensures children are treated in the most appropriate setting likely will increase system costs, but may improve outcomes. A CEA evaluates the cost per life year gained or the cost per quality-adjusted life year (QALY) gained from the trauma system change. CEA is most useful when costeffectiveness ratios can be compared across different interventions such as the cost per life year gained from treating children in pediatric facilities relative to the cost per life year gained from more aggressive treatment for heart failure in elderly adults. If a treatment has a high cost per life year saved, especially relative to other treatments, one could use this information in evaluating whether a given treatment or system change seems warranted. Such comparisons, however, are valid if and only if CEA is performed according to standard methods.The US Public Health Service (USPHS) convened a panel of experts to provide guidelines for conducting CEA of health interventions.1 The resulting reference case analysis developed by the panel embodied the set of standard procedures for conducting CEA. Tilford described issues associated with incorporating the USPHS guidelines in evaluations of emergency medical services for children, 2 especially the recommendation to use QALYs as the metric for measuring health outcomes. 3,4 In particular, the USPHS panel recommended that QALYs be calculated using generic instruments so that health state values (variably refe...

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Preference-weighted Health Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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Measuring the Cost-Effectiveness of Technologic Change in the Treatment of Pediatric Traumatic Brain Injury

Tilford

Aitken

Goodman

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…To address both the issue of complexity over time and the issue of incomplete coverage of long-term sequelae, existing methods have to be adapted or extended. At this stage, the SQM approach has been administered to several burden of injury studies [8][9][10][11]. This approach uses a twostep procedure to assign disability weights to health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Alternative approaches to derive disability weights in injuries: do they make a difference?

et al. 2009

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Background In burden of disease studies, several approaches are used to assess disability weights, a scaling factor necessary to compute years lived with disability (YLD). The aim of this study was to quantify disability weights for injury consequences with two competing approaches, (a) standard QALY/DALY model (SQM) which derives disability weights from patient survey data and (b) the annual profile model (APM) which derives weights for the same patient data valued by a panel. Methods Disability weights were assessed using (a) EQ-5D data from a postal survey among 8,564 injury patients 2, 5, and 9 months after attending the Emergency Department, and (b) preferences of 143 laymen elicited with the time trade-off method. Results Compared with APM, SQM disability weights were consistently higher. YLD calculated with SQM disability weights was more than three times higher compared with YLD calculated with APM disability weights, for mild injuries with short duration, this increase was six fold. Conclusions The APM seems the preferred method in burden of injury studies that includes mild conditions with a rapid course, since the SQM approach might overestimate the impact of the latter. The APM, however, might underestimate the impact of injury consequences, especially in case of severe injuries.

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Quality of life 6 and 18 months after mild traumatic brain injury in early childhood: An exploratory study of the role of genetic, environmental, injury, and child factors

et al. 2020

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Child health-related quality of life following neurocritical care for traumatic brain injury: an analysis of preference-weighted outcomes

Cited by 13 publications

References 45 publications

Measuring the Cost-Effectiveness of Technologic Change in the Treatment of Pediatric Traumatic Brain Injury

Measuring the Cost-Effectiveness of Technologic Change in the Treatment of Pediatric Traumatic Brain Injury

Alternative approaches to derive disability weights in injuries: do they make a difference?

Quality of life 6 and 18 months after mild traumatic brain injury in early childhood: An exploratory study of the role of genetic, environmental, injury, and child factors

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