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Pyne, Sarah 
ORCID: https://orcid.org/0000-0003-0093-9125, Barton, Garry, Turner, David ORCID: https://orcid.org/0000-0002-1689-4147, Mee, Harry, Gregson, Barbara A., Kolias, Angelos G., Turner, Carole, Adams, Hadie, Mohan, Midhun, Uff, Christopher, Hasan, Shumaila, Wilson, Mark, Bulters, Diederik Oliver, Zolnourian, Ardalan, McMahon, Catherine, Stovell, Matthew G., Al-Tamimi, Yahia, Thomson, Simon, Viaroli, Edoardo, Belli, Antonio, King, Andrew, Helmy, Adel E., Timofeev, Ivan, Menon, David and Hutchinson, Peter John
and
For the RESCUE-ASDH Trial collaborators
(2024)
Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma.
BMJ Open, 14 (6).
ISSN 2044-6055
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Abstract
Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. Setting UK secondary care. Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). Trial registration number ISRCTN87370545.
| Item Type: | Article |
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| Additional Information: | Funding Information: No support from any organisation other than the National Institute for Health and Care Research was received for the submitted work. BAG has received consulting fees from Cambridge University Hospitals NHS Foundation Trust. AGK is supported by a Senior Lectureship at the School of Clinical Medicine, University of Cambridge, the Wellcome Trust, and the Royal College of Surgeons of England. MW has received support for attending meetings and/or travel for presentations with the Wilderness Medical Society and Royal College of Surgeons of Edinburgh, is a member of the Trauma Clinical Reference group for the NHS, meetings secretary for the Society of British Neurosurgeons and a non-salaried medical director of GoodSAM. PJH is supported by a Research professorship and Senior Investigator award from the NIHR, the NIHR Cambridge Biomedical Research Centre and the Royal College of Surgeons of England. Funding Information: This project was supported by the Health Technology Assessment (HTA) Programme (project number 12/35/57) and will be published in full in the HTA journal at https://fundingawards.nihr.ac.uk/award/12/35/57; The RESCUE-ASDH trial is an 'embedded study' linked with the CENTER-TBI project (https://www.center-tbi.eu/) of the European Brain Injury Consortium. CENTER-TBI was a large-scale collaborative project, supported by the FP7 Program of the European Union (grant number 602150); RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545. Study protocol is available at https://fundingawards.nihr.ac.uk/ award/12/35/57. We thank the patients who participated in the RESCUE-ASDH trial, their families, and all the collaborating clinicians and research staff, and we thank the staff of the Cambridge Clinical Trials Unit for their support. Publisher Copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. |
| Uncontrolled Keywords: | brain injuries,health economics,neurosurgery,randomized controlled trial,medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Population Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 20 Aug 2024 12:30 |
| Last Modified: | 19 Dec 2024 01:12 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/96281 |
| DOI: | 10.1136/bmjopen-2024-085084 |
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