Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis.
OBJECTIVE
To investigate the cost-effectiveness of computed tomography (CT) relative to radiography for cervical spine screening in trauma patients.


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).


CONCLUSIONS
CT is the preferred cervical spine screening modality in trauma patients at high and moderate risk for cervical spine fracture.
Department of Radiology, University of North Carolina-Chapel Hill School of Medicine 27599-7510, USA.
C C
CC
Blackmore
S D
SD
Ramsey
F A
FA
Mann
R A
RA
Deyo
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010243:Paralysis / Q000000981:diagnostic imaging / Q000191:economics; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000191:economics; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*