Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial).
Br J Surg
; 108(3): 277-285, 2021 04 05.
Article
em En
| MEDLINE
| ID: mdl-33793734
ABSTRACT
BACKGROUND:
The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation.METHODS:
In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive.RESULTS:
A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were 25 809 (95 per cent bias-corrected and accelerated (bca) c.i. 22 617 to 29 137) for the iTBCT group and 26 155 (23 050 to 29 344) for the STWU group, a difference per patient in favour of iTBCT of 346 (4987 to 4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference -5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9).CONCLUSION:
Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
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Avaliacao_economica
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Traumatismo Múltiplo
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Tomografia Computadorizada por Raios X
/
Imagem Corporal Total
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Health_economic_evaluation
Aspecto:
Patient_preference
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Br J Surg
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Holanda