Cost-Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia.

BACKGROUND: Epidural hematoma (EDH) is a common and potentially deadly occurrence following a severe traumatic brain injury. Our aim was to determine whether craniotomy is cost-effective when indicated for the treatment of EDH when a trained neurosurgeon is available. METHODS: A decision tree was used to model the cost-effectiveness of craniotomy available versus craniotomy unavailable for the management of traumatic EDH from a Cambodian societal and provider perspective. Costs and effectiveness parameters were obtained from patient data at a large government hospital in Cambodia. Outcomes were measured in quality-adjusted life years (QALYs). Incremental cost per QALY and budget impact were calculated for each intervention at a willingness-to-pay (WTP) threshold of $9787.80/QALY (3× GDP per capita PPP). The time horizon reflected full life span, and costs and QALYs were discounted at 3%. Sensitivity analysis was also conducted. RESULTS: Compared to craniotomy unavailable for EDH ($945.80; 11.78 QALYs), craniotomy available came at a higher cost and greater effectiveness ($1520.73; 12.78 QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $574.93. One-way analysis demonstrated that craniotomy unavailable became more cost-effective than craniotomy available when the percent chance of having a GOS of 4 or 5 was 60% for patients with an EDH where craniotomy was indicated but not performed. Probabilistic sensitivity analysis revealed that craniotomy available was more cost-effective than conservative management in 84.4% of simulations at the WTP threshold. CONCLUSIONS: Craniotomy is a cost-effective treatment for patients with a traumatic EDH who meet criteria for operation when trained neurosurgeons are available onsite.

Incidence, hospital costs and in-hospital mortality rates of epidural hematoma in the United States.

OBJECTIVE: This study provides the first United States (US) national data regarding frequency, cost and mortality rate of epidural hematoma (EDH) and determines the factors affecting the morbidity and deaths in the patients with EDH undergoing surgical evacuation. METHODS: A retrospective analysis was performed by searching the Nationwide Inpatient Sample (NIS) from 2003 to 2010, the largest all payer database of non-federal community hospitals in the US. All cases of EDH were indentified using ICD-9 codes. RESULTS: A total of 5189 admissions were identified in the NIS database, and incidence was highest in the second decade (33.4%). The median length of stay in the hospital was about 4 days in each year (2003-2010) without significant difference. The percent of discharge disposition other than home was about 2-3% in the entire cohort, with the highest in 2009 (3%). The average cost per admission increased significantly (80%) from $45,850 in 2003 to $82,800 in 2010. The inhospital mortality and complication rate was 3.5% and 2.9%, respectively. Factors affecting in-hospital mortality rate were age (≤18 yr vs. >18 yr, P<0.001), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital volume (high vs. low volume, P<0.001), physician's case volumes (high vs. low volume, P<0.02), hospital type (teaching vs. non-teaching, P<0.01) and hospital region (South vs. others, P<0.02). Similarly, factors affecting adverse outcome at discharge were age (≤18 yr vs. >18 yr, P<0.001), female gender (P<0.001), median income (fourth quartile vs. other, P<0.001), ethnicity (African-American vs. non-African-American, P<0.02), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital case volume (4th quartile volume vs. other, P<0.001), physician's case volume (4th quartile volume vs. other, P<0.0001), hospital type (teaching vs. non-teaching, hospital bed size (small vs. large, P<0.001), hospital region (Northeast vs. others, P<0.001) and hospital location (urban vs. rural, P<0.001). CONCLUSION: Nationally, there has been no significant change in the frequency of EDH. However, its cost is increasing rapidly.

Routine early CT-scan is cost saving after minor head injury.

Significant hospital resources are invested in early detection of intracranial complications after minor head injuries (MHI). This study focuses on economic aspects of MHI management. 88 MHI patients underwent routine early CT-scan and at least 24 h in-hospital observation. The cost of this management was calculated, and compared to estimated costs of three alternative management protocols. CT-scans demonstrated intracranial lesions in eight (9%) patients, but none required neurosurgical intervention. The expense of our management was Norwegian Kroner (NOK) 576,136. An alternative management protocol including routing early CT-scan and discharge of patients with normal CT-findings, Glasgow coma score > or = 14 and no neurological deficits, was found to be safe, and estimated to reduce costs with 43% to NOK 326,669. It is concluded that routine early CT-scan is the most reliable and cost saving management procedure after MHI.