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Radiology. 1999 Jul;212(1):117-25.

Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis.

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1
Department of Radiology, University of North Carolina-Chapel Hill School of Medicine 27599-7510, USA.

Abstract

PURPOSE:

To investigate the cost-effectiveness of computed tomography (CT) relative to radiography for cervical spine screening in trauma patients.

MATERIALS AND METHODS:

A decision analysis model was constructed to compare the incremental cost-effectiveness of radiography and CT as primary cervical spine screening modalities in trauma patients. Analyses were performed from a societal perspective, and probability and cost estimates from the literature and institutional experience were used. In separate cost-effectiveness analyses, hypothetical cohorts of trauma patients from three defined clinical scenarios were considered: high, moderate, and low risk for cervical spine fracture. Outcome measures included cases of paralysis prevented, total cost of screening strategies, and incremental cost-effectiveness ratios.

RESULTS:

In high-risk patients, screening with CT is a dominant strategy that prevents cases of paralysis and saves money for society. In moderate-risk patients, screening with CT is cost-effective with reference-case assumptions and within the range of most sensitivity analyses. In the low-risk group, CT screening helps prevent cases of paralysis, but the incremental cost-effectiveness ratio is high (> $80,000 per quality-adjusted life year).

CONCLUSION:

CT is the preferred cervical spine screening modality in trauma patients at high and moderate risk for cervical spine fracture.

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