Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial

doi:10.1136/bmj.38918.659120.4F

BMJ 2006;333:469 (2 September), doi:10.1136/bmj.38918.659120.4F (published 8 August 2006)

Research

Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial

Anders Norlund, health economist³, Lars-Åke Marké, health economist³, Jean-Luc af Geijerstam, researcher¹, Sven Oredsson, head of emergency department², Mona Britton, senior medical adviser³, OCTOPUS Study

¹ Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, 171 76 Stockholm, Sweden, ² Emergency Department, Helsingborg Hospital, Helsingborg, Sweden, ³ Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden

Correspondence to: J-L af Geijerstam jean-luc.af.geijerstam{at}ki.se

Abstract

Objective To compare the costs of immediate computed tomographyduring triage for admission with those of observation in hospitalin patients with mild head injury.

Design Prospective cost effectiveness analysis within a multicentre,pragmatic randomised trial.

Setting 39 acute hospitals in Sweden

Participants 2602 patients (aged $≥$ 6) with mild head injury.

Interventions Immediate computed tomography or admission forobservation.

Main outcome measures Direct and indirect costs related to themild head injury during the acute and three month follow-upperiod.

Results Outcome after three months was similar for both strategies(non-significantly in favour of computed tomography). For theacute stage and complications, the cost was 461 euros (£314,$582) per patient in the computed tomography group and 677 euros(£462, $854) in the observation group; an average of 32%less in the computed tomography group (216 euros, 95% confidenceinterval -272 to -164; P < 0.001). Sensitivity analysis showedthat computed tomography was the most cost effective strategyunder a broad range of assumptions. After three months, totalcosts were 718 euros and 914 euros per patient—that is,196 euros less in the computed tomography group (- 281 to -114; P < 0.001). The lower cost of the computed tomographystrategy at the acute stage thus remained unchanged during follow-up.

Conclusion Patients with mild head injury attending an emergencydepartment can be managed more cost effectively with computedtomography rather than admission for observation in hospital.

Trial registration ISRCTN81464462 [controlled-trials.com] .

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Rapid Responses:

Read all Rapid Responses

What about the radiation cost?: Sanjay P Prabhu
bmj.com, 12 Aug 2006 [Full text]
Author's reply: Anders Norlund
bmj.com, 24 Aug 2006 [Full text]
Admission for minor head injury is expensive and ineffective: Steve Goodacre
bmj.com, 4 Sep 2006 [Full text]
CT for Mild Head Injury: Irradiation Issues: Jane L Ferguson, et al.
bmj.com, 10 Oct 2006 [Full text]