Mild head injury: observation or computed tomography? Economic aspects by literature review and decision analysis.
OBJECTIVE
To compare the costs of two strategies for acute management of mild head injury: inhospital observation compared with acute computed tomography (CT) and home care.


METHODS
Studies comparing costs for the two strategies that seem to have similar outcomes for patients were systematically reviewed. A decision tree analysis to compare the costs was also constructed, based on Swedish national costs and the risks found in a recent review on mild head injury complications.


RESULTS
No studies were found that directly measured and compared risks, benefits, and costs of the two strategies. In the four studies retrieved, involving 4126 patients, the costs for hospital observation were factual, but a model was used to evaluate costs for the CT strategy. On average, costs were one third lower with CT. Also, the decision tree analysis demonstrated that the CT strategy was one third less expensive than inhospital observation. A sensitivity analysis showed this to be valid for nearly all cases. If these calculations hold true, a change of strategy could result in annual savings of pound 280,000/million inhabitants.


CONCLUSIONS
The CT strategy seems to cost one third less than hospital observation.
Af Geijerstam
J L
JL
The Swedish Council on Technology Assessment in Health Care (SBU) Department of Medicine, Unit of Clinical Epidemiology, Karolinska Hospital, Stockholm, Sweden. jean-luc.af.geijerstam@medks.ki.se
Britton
M
M
Marké
L A
LA
D003365:Costs and Cost Analysis; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000191:economics; D003663:Decision Trees; D004630:Emergencies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D018579:Patient Selection; D011859:Radiography; D016896:Treatment Outcome