Moran Dane, Shrime Mark G, Nang Sam, Vycheth Iv, Vuthy Din, Hong Raksmey, Padula William V, Park Kee B
Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
World J Surg. 2017 Sep;41(9):2215-2223. doi: 10.1007/s00268-017-4022-7.
Epidural hematoma (EDH) is a common and potentially deadly occurrence following a severe traumatic brain injury. Our aim was to determine whether craniotomy is cost-effective when indicated for the treatment of EDH when a trained neurosurgeon is available.
A decision tree was used to model the cost-effectiveness of craniotomy available versus craniotomy unavailable for the management of traumatic EDH from a Cambodian societal and provider perspective. Costs and effectiveness parameters were obtained from patient data at a large government hospital in Cambodia. Outcomes were measured in quality-adjusted life years (QALYs). Incremental cost per QALY and budget impact were calculated for each intervention at a willingness-to-pay (WTP) threshold of $9787.80/QALY (3× GDP per capita PPP). The time horizon reflected full life span, and costs and QALYs were discounted at 3%. Sensitivity analysis was also conducted.
Compared to craniotomy unavailable for EDH ($945.80; 11.78 QALYs), craniotomy available came at a higher cost and greater effectiveness ($1520.73; 12.78 QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $574.93. One-way analysis demonstrated that craniotomy unavailable became more cost-effective than craniotomy available when the percent chance of having a GOS of 4 or 5 was 60% for patients with an EDH where craniotomy was indicated but not performed. Probabilistic sensitivity analysis revealed that craniotomy available was more cost-effective than conservative management in 84.4% of simulations at the WTP threshold.
Craniotomy is a cost-effective treatment for patients with a traumatic EDH who meet criteria for operation when trained neurosurgeons are available onsite.
硬膜外血肿（EDH）是严重创伤性脑损伤后常见且可能致命的情况。我们的目的是确定在有训练有素的神经外科医生的情况下，开颅手术用于治疗EDH时是否具有成本效益。
从柬埔寨社会和医疗服务提供者的角度，使用决策树对有开颅手术条件与无开颅手术条件下外伤性EDH管理的成本效益进行建模。成本和效果参数取自柬埔寨一家大型政府医院的患者数据。结果以质量调整生命年（QALYs）衡量。在支付意愿（WTP）阈值为9787.80美元/QALY（人均GDP购买力平价的3倍）的情况下，计算每种干预措施的每QALY增量成本和预算影响。时间范围反映整个寿命期，成本和QALYs按3%进行贴现。还进行了敏感性分析。
与无EDH开颅手术条件的情况（945.80美元；11.78 QALYs）相比，有开颅手术条件的情况成本更高但效果更好（1520.73美元；12.78 QALYs），导致增量成本效益比（ICER）为574.93美元。单向分析表明，对于有EDH且有开颅手术指征但未进行手术的患者，当格拉斯哥预后评分（GOS）为4或5的百分比机会为60%时，无开颅手术条件的情况比有开颅手术条件的情况更具成本效益。概率敏感性分析显示，在WTP阈值下，84.4%的模拟中，有开颅手术条件的情况比保守治疗更具成本效益。
对于符合手术标准的外伤性EDH患者，在现场有训练有素的神经外科医生时，开颅手术是一种具有成本效益的治疗方法。
