Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands.
Trauma Unit, Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
Br J Surg. 2021 Apr 5;108(3):277-285. doi: 10.1093/bjs/znaa091.
The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation.
In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive.
A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference -5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9).
Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
在严重创伤患者中，立即全身 CT（iTBCT）对健康经济方面的影响是一个报道不足的问题。本研究旨在确定 iTBCT 与选择性 CT（标准检查（STWU））相比在初始创伤评估期间的成本效益。
在这项多中心 RCT 中，将高度怀疑有严重损伤的成年患者在院内随机分为 iTBCT 或 STWU 组。确定损伤后 6 个月内的医院医疗保健成本。计算了 iTBCT 对于每个额外存活患者的不同意愿支付水平的成本效益概率。
共纳入 928 例具有完整临床随访的荷兰患者。iTBCT 组的医院治疗费用平均为 25809 欧元（95%偏倚校正和加速（bca）置信区间（ci）为 22617 至 29137 欧元），STWU 组为 26155 欧元（23050 至 29344 欧元），iTBCT 组每个患者的费用差异为 346 欧元（4987 至 4328 欧元）（P=0.876）。6 个月时存活患者的比例无差异。iTBCT 组的无严重发病率存活患者比例为 61.6%，STWU 组为 66.7%（差异-5.1%；P=0.104）。在保持患者存活方面，iTBCT 的成本效益概率在整个组中仍低于 0.56，但在多发伤患者中更高（0.8-0.9），在创伤性脑损伤患者中更高（超过 0.9）。
从医院医疗保健提供者的角度来看，在多发伤或创伤性脑损伤患者中，iTBCT 应作为首选的诊断策略。
