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

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 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...

One-year costs of intensive care in pediatric patients with traumatic brain injury

“…There are some data on the cost of ICUtreated pediatric TBI; however, these data usually account for hospital costs only. [5][6][7][8] After intensive care, some TBI patients need long rehabilitation periods to regain independence. Little is known about the total healthcare costs of ICU-treated pediatric TBI patients.…”