School of Health and Related Research, The University of Sheffield, , Sheffield, England.
Arch Dis Child. 2013 Dec;98(12):939-44. doi: 10.1136/archdischild-2012-302820. Epub 2013 Aug 22.
To estimate the cost-effectiveness of diagnostic management strategies for children with minor head injury and identify an optimal strategy.
A probabilistic decision analysis model was developed to estimate the costs and quality-adjusted life years (QALYs) accrued by each of six potential management strategies for minor head injury, including a theoretical 'zero option' strategy of discharging all patients home without investigation. The model took a lifetime horizon and the perspective of the National Health Service.
The optimal strategy was based on the Children's Head injury Algorithm for the prediction of Important Clinical Events (CHALICE) rule, although the costs and outcomes associated with each strategy were broadly similar.
Liberal use of CT scanning based on a high sensitivity decision rule is not only effective but also cost saving, with the CHALICE rule being the optimal strategy, although there is some uncertainty in the results. Incremental changes in the costs and QALYs are very small when all selective CT strategies are compared. The estimated cost of caring for patients with brain injury worsened by delayed treatment is very high compared with the cost of CT scanning. This analysis suggests that all hospitals receiving children with minor head injury should have unrestricted access to CT scanning for use in conjunction with evidence-based guidelines.
评估儿童轻度头部损伤的诊断管理策略的成本效益，并确定最佳策略。
开发了一种概率决策分析模型，以估计六种潜在管理策略（包括一种理论上的“零选项”策略，即不进行任何调查就将所有患者送回家）对儿童轻度头部损伤的成本和质量调整生命年（QALY）的影响。该模型采用了终生的视角和国民保健制度的观点。
最佳策略基于儿童头部损伤用于预测重要临床事件的算法（CHALICE）规则，尽管每种策略的成本和结果大致相似。
基于高灵敏度决策规则的 CT 扫描的广泛应用不仅有效，而且具有成本效益，CHALICE 规则是最佳策略，尽管结果存在一定的不确定性。与所有选择性 CT 策略相比，成本和 QALY 的增量变化非常小。与 CT 扫描相比，因延迟治疗而导致脑损伤恶化的患者的治疗费用非常高。这项分析表明，所有接收轻度头部损伤儿童的医院都应不受限制地获得 CT 扫描，以便与循证指南一起使用。
