Cost Effectiveness of Intracranial Pressure Monitoring in Pediatric Patients with Severe Traumatic Brain Injury: A Simulation Modeling Approach

Zapata-Vázquez, Rita Esther; Álvarez-Cervera, Fernando J.; Alonzo-Vázquez, Felipe; García-Lira, José Ramón; Granados-García, Víctor; Pérez-Herrera, Norma; Medina-Moreno, Manuel R.

doi:10.1016/j.vhri.2017.08.011

Cited by 7 publications

(10 citation statements)

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“…[34, 35] Nineteen studies were conducted in high income countries of which sixteen in the USA. The majority of studies focused on adult patients, while some studies focused on paediatric [34, 36–38] and elderly patients. [35, 39] Nineteen studies (76%) had cost research in TBI patients as a research objective.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies achieved a score above 80%, representing “high quality”. [36, 38, 39, 47, 50, 53, 58] Especially items in the ‘cost data’ subgroup scored poorly (49%). All but one study mentioned their cost data source, but a clear description was missing in 24%.…”

Section: Resultsmentioning

confidence: 99%

“…[35, 36, 38, 40, 43, 45–47, 50–52, 54–56] ICU LOS ranged from 7.9 to 25.8 days (GCS≤8) [40, 43], 6 to 19 days (AIS≥4) and 6 to 21 days (AIS≥5). [35, 47] Hospital LOS ranged from 10 to 36.8 days (GCS≤8) [38, 54], 10 to 26.1 days (AIS≥4) [47, 52] and 11 to 17.5 days (AIS≥5). [46, 47]…”

Section: Resultsmentioning

confidence: 99%

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In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment

et al. 2019

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Background The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe TBI (s-TBI). To improve future treatment decision-making, resource allocation and research initiatives, this study reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology. Methods A systematic search was performed using the following databases: PubMed, MEDLINE, Embase, Web of Science, Cochrane library, CENTRAL, Emcare, PsychINFO, Academic Search Premier and Google Scholar. Articles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement. Results Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% - 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported. Conclusions Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment

et al. 2019

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“…As in other studies, the main cost drivers in this current study were LOS and/or admission (66%), surgery (12%), radiology (7%), labs (4%) and other costs (11%) [2,41,81]. Inhospital costs were generally higher for the more severely injured patients [35,41], with a lower GCS [24,41,48,63,69] or pupillary abnormalities [70].…”

Section: In-hospital Costssupporting

confidence: 56%

“…Inhospital costs were generally higher for the more severely injured patients [35,41], with a lower GCS [24,41,48,63,69] or pupillary abnormalities [70]. Higher costs were related to an increased healthcare consumption with longer LOS [2,48], specialised intensive care unit (ICU) treatment [2] and a more frequent use of ICP monitoring [37,61,81] and surgical procedures [41,70,80]. The presence of TBI normally increases the LOS of general admissions [62], but extracranial injury and higher overall injury severity in addition to TBI also contributed to higher in-hospital healthcare consumption and in-hospital costs [13,57,80].…”

Section: In-hospital Costsmentioning

confidence: 99%

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

et al. 2020

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Background The high occurrence and acute and chronic sequelae of traumatic brain injury (TBI) cause major healthcare and socioeconomic challenges. This study aimed to describe outcome, in-hospital healthcare consumption and in-hospital costs of patients with TBI. Methods We used data from hospitalised TBI patients that were included in the prospective observational CENTER-TBI study in three Dutch Level I Trauma Centres from 2015 to 2017. Clinical data was completed with data on in-hospital healthcare consumption and costs. TBI severity was classified using the Glasgow Coma Score (GCS). Patient outcome was measured by inhospital mortality and Glasgow Outcome Score-Extended (GOSE) at 6 months. In-hospital costs were calculated following the Dutch guidelines for cost calculation. Results A total of 486 TBI patients were included. Mean age was 56.1 ± 22.4 years and mean GCS was 12.7 ± 3.8. Six-month mortality (4.2%-66.7%), unfavourable outcome (GOSE ≤ 4) (14.6%-80.4%) and full recovery (GOSE = 8) (32.5%-5.9%) rates varied from patients with mild TBI (GCS13-15) to very severe TBI (GCS3-5). Length of stay (8 ± 13 days) and in-hospital costs (€11,920) were substantial and increased with higher TBI severity, presence of intracranial abnormalities, extracranial injury and surgical intervention. Costs were primarily driven by admission (66%) and surgery (13%). Conclusion In-hospital mortality and unfavourable outcome rates were rather high, but many patients also achieved full recovery. Hospitalised TBI patients show substantial in-hospital healthcare consumption and costs, even in patients with mild TBI. Because these costs are likely to be an underestimation of the actual total costs, more research is required to investigate the actual costseffectiveness of TBI care. Keywords Traumatic brain injury. In-hospital costs. Mortality. Functional outcome This article is part of the Topical Collection on Brain trauma Electronic supplementary material The online version of this article (

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Non-invasive ICP Monitoring by Auditory System Measurements

Dhar

Sandler

Manwaring

et al. 2023

Signal Processing in Medicine and Biology

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Cost Effectiveness of Intracranial Pressure Monitoring in Pediatric Patients with Severe Traumatic Brain Injury: A Simulation Modeling Approach

Abstract: The results of the model suggest that ICP monitoring is cost effective because there was a monetary gain in terms of the incremental net monetary benefit.

Cited by 7 publications

References 40 publications

In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment

In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment

Functional outcome, in-hospital healthcare consumption and in-hospital costs for hospitalised traumatic brain injury patients: a Dutch prospective multicentre study

Non-invasive ICP Monitoring by Auditory System Measurements

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