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Br J Neurosurg. 2016 Aug;30(4):388-96. doi: 10.3109/02688697.2016.1161166. Epub 2016 May 18.

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

Author information

1
a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK ;
2
b National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London , UK ;
3
c School of Health and Related Research, University of Sheffield , Sheffield , UK ;
4
d School of Clinical Medicine, University of Cambridge , Cambridge , UK ;
5
e Clinical Trials Unit, Intensive Care National Audit and Research Centre , London , UK.

Abstract

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, £11,123 to £18,880) compared with 'late or no transfer' (N = 263). The lifetime cost per QALY gained for 'early' transfer was £11,000.

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.

KEYWORDS:

Cost-effectiveness analysis; neurocritical care; traumatic brain injury

PMID:
27188663
DOI:
10.3109/02688697.2016.1161166
[Indexed for MEDLINE]
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