An evaluation of the clinical and cost-effectiveness of alternative care locations for critically ill adult patients with acute traumatic brain injury

作者：Grieve R^*; Sadique Z; Gomes M; Smith M; Lecky F E; Hutchinson P J A; Menon D K; Rowan K M; Harrison D A

来源：British Journal of Neurosurgery, 2016, 30(4): 388-396.

DOI：10.3109/02688697.2016.1161166

• Cost-effectiveness analysis
• neurocritical care
• traumatic brain injury

Background: For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) Early' transfer to a neuroscience centre versus no or late' transfer for those who present at a non-neuroscience centre.Methods: The Risk Adjustment In Neurocritical care (RAIN) Study included prospective admissions following acute TBI to 67 UK adult critical care units during 2009-11. Data were collected on baseline case-mix, mortality, resource use, and at six months, Glasgow Outcome Scale Extended (GOSE), and quality of life (QOL) (EuroQol 5D-3L). We report incremental effectiveness, costs and cost per Quality-Adjusted Life Year (QALY) of the alternative care locations, adjusting for baseline differences with validated risk prediction models. We tested the robustness of results in sensitivity analyses.Findings: Dedicated neurocritical care unit patients (N=1324) had similar six-month mortality, higher QOL (mean gain 0.048, 95% CI -0.002 to 0.099) and increased average costs compared with those managed in combined neuro/general units (N=1341), with a lifetime cost per QALY gained of 14,000. Early' transfer to a neuroscience centre (N=584) was associated with lower mortality (odds ratio 0.52, 0.34-0.80), higher QOL for survivors (mean gain 0.13, 0.032-0.225), but positive incremental costs (15,001 pound, 11,123 pound to 18,880) pound compared with late or no transfer' (N=263). The lifetime cost per QALY gained for early' transfer was 11,000 pound.Conclusions: For critically ill adult patients with acute TBI, within neuroscience centres management in dedicated neurocritical care units versus combined neuro/general units led to improved QoL and higher costs, on average, but these differences were not statistically significant. This study finds that early' transfer to a neuroscience centre is associated with reduced mortality, improvement in QOL and is cost-effective.

• 出版日期2016-8