title: Cost-effectiveness of decompressive craniectomy in non-traumatic neurological emergencies.
abstract: BACKGROUND
  Decompressive craniectomy is used regularly in traumatic brain injury (TBI) and malignant middle cerebral artery infarction. Its benefits for other causes of non-traumatic brain swelling, if any, are unclear, especially after a devastating primary event.
  
  
  METHODS
  We evaluated the outcomes as well as treatment costs of all emergency decompressive craniectomies performed between the 2000 and 2006 in a single institution to lower intractable intracranial pressure, excluding the standard indications TBI and malignant middle cerebral infarction. The health-related quality of life (HRQoL) was evaluated on the Euroqol (EQ-5D) scale, and cost of a quality-adjusted life year (QALY) calculated.
  
  
  RESULTS
  The overall 3-year mortality rate was 62% for subarachnoid haemorrhage (SAH, 29 patients) and 31% for other neurological emergencies (13 patients). Patients with SAH were on average 13 years older than the other indications mean. Of the non-survivors, 45% died within a month and 95% within 1 year. Median EQ-5D index values were poor (0.15 for SAH and 0.62 for the other emergencies, versus 0.85 for the normal population), but of the survivors, 73% and 89% were able to live at home. The cost of neurosurgical treatment for one QALY was 11,000 € for SAH and 2000 € for other emergencies.
  
  
  CONCLUSIONS
  Mortality after non-traumatic neurological emergencies leading to decompressive craniectomy was high, and the HRQoL index of the survivors was poor. Most survivors were, however, able to live at home, and the cost of neurosurgical treatment for a QALY gained was acceptable.
authors.affiliation: Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Malmivaara
authors.forename: J
authors.initials: J
authors.lastname: Ohman
authors.forename: R
authors.initials: R
authors.lastname: Kivisaari
authors.forename: J
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: J
authors.initials: J
authors.lastname: Siironen
mesh_terms: D000293:Adolescent; D000328:Adult; D001929:Brain Edema / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D056424:Decompressive Craniectomy / Q000191:economics*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000601:surgery; D055815:Young Adult