title: Cost-effectiveness of decompressive craniectomy in traumatic brain injuries.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) is used regularly in traumatic brain injury (TBI). There are, however, no cost-effectiveness studies of the procedure.
  
  
  METHODS
  We evaluated the outcomes and treatment costs of all decompressive craniectomies performed between the 2000 and 2006 in a single institution to lower intractable intracranial pressure after TBI. The health-related quality of life was evaluated on the Euroqol (EQ-5D) questionnaire and on the visual-analogue scale (VAS), and cost of a quality-adjusted life year (QALY) was calculated.
  
  
  RESULTS
  In this study of 54 patients, the median follow-up time was 5.6 years. Overall mortality rate was 41%. Of the 22 non-survivors, 73% died within 30 days. For 32 survivors, the median EQ-5D index value was 0.85, which is equal to the normal population. The median VAS value was 73, whilst normal population's value is 80. Of the survivors, 81% (26/32) were able to live at home and 31% (10/32) returned to work. The cost of neurosurgical treatment for one QALY was 2400 €. Estimation for all medical costs, including rehabilitation and anticipated future costs, resulted cost of a QALY 17,900 €.
  
  
  CONCLUSIONS
  Mortality after severe TBI leading to DC was high, but amongst the survivors, the health-related quality of life was equal to normal population. Most survivors were able to live at home and were almost as satisfied with their health as in general people are. Cost of neurosurgical treatment was low, and also including all evaluated costs, cost of a QALY gained was acceptable.
authors.affiliation: Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland. kirsi.malmivaara@helsinki.fi
authors.forename: K
authors.initials: K
authors.lastname: Malmivaara
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; D000368:Aged; D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D056424:Decompressive Craniectomy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult