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.
Blackmore
C C
CC
Department of Radiology, University of North Carolina-Chapel Hill School of Medicine 27599-7510, USA.
Ramsey
S D
SD
Mann
F A
FA
Deyo
R A
RA
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*