title: Minor head injury: CT-based strategies for management--a cost-effectiveness analysis.
abstract: OBJECTIVE
  To compare the cost-effectiveness of using selective computed tomographic (CT) strategies with that of performing CT in all patients with minor head injury (MHI).
  
  
  METHODS
  The internal review board approved the study; written informed consent was obtained from all interviewed patients. Five strategies were evaluated, with CT performed in all patients with MHI; selectively according to the New Orleans criteria (NOC), Canadian CT head rule (CCHR), or CT in head injury patients (CHIP) rule; or in no patients. A decision tree was used to analyze short-term costs and effectiveness, and a Markov model was used to analyze long-term costs and effectiveness. n-Way and probabilistic sensitivity analyses and value-of-information (VOI) analysis were performed. Data from the multicenter CHIP Study involving 3181 patients with MHI were used. Outcome measures were first-year and lifetime costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Study results showed that performing CT selectively according to the CCHR or the CHIP rule could lead to substantial U.S. cost savings ($120 million and $71 million, respectively), and the CCHR was the most cost-effective at reference-case analysis. When the prediction rule had lower than 97% sensitivity for the identification of patients who required neurosurgery, performing CT in all patients was cost-effective. The CHIP rule was most likely to be cost-effective. At VOI analysis, the expected value of perfect information was $7 billion, mainly because of uncertainty about long-term functional outcomes.
  
  
  CONCLUSIONS
  Selecting patients with MHI for CT renders cost savings and may be cost-effective, provided the sensitivity for the identification of patients who require neurosurgery is extremely high. Uncertainty regarding long-term functional outcomes after MHI justifies the routine use of CT in all patients with these injuries.
authors.affiliation: Department of Radiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Rotterdam, the Netherlands.
authors.forename: Marion
authors.initials: M
authors.lastname: Smits
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Helena M
authors.initials: HM
authors.lastname: Dekker
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Vos
authors.forename: Digna R
authors.initials: DR
authors.lastname: Kool
authors.forename: Daphne A
authors.initials: DA
authors.lastname: van Rijssel
authors.forename: Paul A M
authors.initials: PA
authors.lastname: Hofman
authors.forename: Albert
authors.initials: A
authors.lastname: Twijnstra
authors.forename: Hervé L J
authors.initials: HL
authors.lastname: Tanghe
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000191:economics*; D003663:Decision Trees; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000191:economics*