Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma

Sarah Pyne; Garry Barton; David Turner; Harry Mee; Barbara A. Gregson; Angelos G. Kolias; Carole Turner; Hadie Adams; Midhun Mohan; Christopher Uff; Shumaila Hasan; Mark Wilson; Diederik Oliver Bulters; Ardalan Zolnourian; Catherine McMahon; Matthew G. Stovell; Yahia Al-Tamimi; Simon Thomson; Edoardo Viaroli; Antonio Belli; Andrew King; Adel E. Helmy; Ivan Timofeev; David Menon; Peter John Hutchinson; For the RESCUE-ASDH Trial collaborators

doi:10.1136/bmjopen-2024-085084

Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma

Sarah Pyne, Garry Barton, David Turner, Harry Mee, Barbara A. Gregson, Angelos G. Kolias, Carole Turner, Hadie Adams, Midhun Mohan, Christopher Uff, Shumaila Hasan, Mark Wilson, Diederik Oliver Bulters, Ardalan Zolnourian, Catherine McMahon, Matthew G. Stovell, Yahia Al-Tamimi, Simon Thomson, Edoardo Viaroli, Antonio BelliAndrew King, Adel E. Helmy, Ivan Timofeev, David Menon, Peter John Hutchinson, For the RESCUE-ASDH Trial collaborators

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Abstract

Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH).

Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial.

Setting UK secondary care.

Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).

Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).

Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists.

Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE.

Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant).

Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076).

Trial registration number ISRCTN87370545.

Original language	English
Article number	e085084
Journal	BMJ Open
Volume	14
Issue number	6
Early online date	16 Jun 2024
DOIs	https://doi.org/10.1136/bmjopen-2024-085084
Publication status	Published - 16 Jun 2024

Keywords

brain injuries
health economics
neurosurgery
randomized controlled trial

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Pyne, S., Barton, G., Turner, D., Mee, H., Gregson, B. A., Kolias, A. G., Turner, C., Adams, H., Mohan, M., Uff, C., Hasan, S., Wilson, M., Bulters, D. O., Zolnourian, A., McMahon, C., Stovell, M. G., Al-Tamimi, Y., Thomson, S., Viaroli, E., ... For the RESCUE-ASDH Trial collaborators (2024). Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma. BMJ Open, 14(6), [e085084]. https://doi.org/10.1136/bmjopen-2024-085084

Pyne, Sarah ; Barton, Garry ; Turner, David ; Mee, Harry ; Gregson, Barbara A. ; Kolias, Angelos G. ; Turner, Carole ; Adams, Hadie ; Mohan, Midhun ; Uff, Christopher ; Hasan, Shumaila ; Wilson, Mark ; Bulters, Diederik Oliver ; Zolnourian, Ardalan ; McMahon, Catherine ; Stovell, Matthew G. ; Al-Tamimi, Yahia ; Thomson, Simon ; Viaroli, Edoardo ; Belli, Antonio ; King, Andrew ; Helmy, Adel E. ; Timofeev, Ivan ; Menon, David ; Hutchinson, Peter John ; For the RESCUE-ASDH Trial collaborators. / Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma. In: BMJ Open. 2024 ; Vol. 14, No. 6.

@article{c8e1b0b8611e4a90bbe719187c7c6cf0,

title = "Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma",

abstract = "Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. Setting UK secondary care. Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). Trial registration number ISRCTN87370545. ",

keywords = "brain injuries, health economics, neurosurgery, randomized controlled trial",

author = "Sarah Pyne and Garry Barton and David Turner and Harry Mee and Gregson, {Barbara A.} and Kolias, {Angelos G.} and Carole Turner and Hadie Adams and Midhun Mohan and Christopher Uff and Shumaila Hasan and Mark Wilson and Bulters, {Diederik Oliver} and Ardalan Zolnourian and Catherine McMahon and Stovell, {Matthew G.} and Yahia Al-Tamimi and Simon Thomson and Edoardo Viaroli and Antonio Belli and Andrew King and Helmy, {Adel E.} and Ivan Timofeev and David Menon and Hutchinson, {Peter John} and {For the RESCUE-ASDH Trial collaborators}",

note = "Funding Information: No support from any organisation other than the National Institute for Health and Care Research was received for the submitted work. BAG has received consulting fees from Cambridge University Hospitals NHS Foundation Trust. AGK is supported by a Senior Lectureship at the School of Clinical Medicine, University of Cambridge, the Wellcome Trust, and the Royal College of Surgeons of England. MW has received support for attending meetings and/or travel for presentations with the Wilderness Medical Society and Royal College of Surgeons of Edinburgh, is a member of the Trauma Clinical Reference group for the NHS, meetings secretary for the Society of British Neurosurgeons and a non-salaried medical director of GoodSAM. PJH is supported by a Research professorship and Senior Investigator award from the NIHR, the NIHR Cambridge Biomedical Research Centre and the Royal College of Surgeons of England. Funding Information: This project was supported by the Health Technology Assessment (HTA) Programme (project number 12/35/57) and will be published in full in the HTA journal at https://fundingawards.nihr.ac.uk/award/12/35/57; The RESCUE-ASDH trial is an 'embedded study' linked with the CENTER-TBI project (https://www.center-tbi.eu/) of the European Brain Injury Consortium. CENTER-TBI was a large-scale collaborative project, supported by the FP7 Program of the European Union (grant number 602150); RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545. Study protocol is available at https://fundingawards.nihr.ac.uk/ award/12/35/57. We thank the patients who participated in the RESCUE-ASDH trial, their families, and all the collaborating clinicians and research staff, and we thank the staff of the Cambridge Clinical Trials Unit for their support. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.",

year = "2024",

month = jun,

day = "16",

doi = "10.1136/bmjopen-2024-085084",

language = "English",

volume = "14",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

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Pyne, S , Barton, G , Turner, D, Mee, H, Gregson, BA, Kolias, AG, Turner, C, Adams, H, Mohan, M, Uff, C, Hasan, S, Wilson, M, Bulters, DO, Zolnourian, A, McMahon, C, Stovell, MG, Al-Tamimi, Y, Thomson, S, Viaroli, E, Belli, A, King, A, Helmy, AE, Timofeev, I, Menon, D, Hutchinson, PJ & For the RESCUE-ASDH Trial collaborators 2024, 'Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma', BMJ Open, vol. 14, no. 6, e085084. https://doi.org/10.1136/bmjopen-2024-085084

Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma. / Pyne, Sarah ; Barton, Garry ; Turner, David; Mee, Harry; Gregson, Barbara A.; Kolias, Angelos G.; Turner, Carole; Adams, Hadie; Mohan, Midhun; Uff, Christopher; Hasan, Shumaila; Wilson, Mark; Bulters, Diederik Oliver; Zolnourian, Ardalan; McMahon, Catherine; Stovell, Matthew G.; Al-Tamimi, Yahia; Thomson, Simon; Viaroli, Edoardo; Belli, Antonio; King, Andrew; Helmy, Adel E.; Timofeev, Ivan; Menon, David; Hutchinson, Peter John; For the RESCUE-ASDH Trial collaborators.

In: BMJ Open, Vol. 14, No. 6, e085084, 16.06.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma

AU - Pyne, Sarah

AU - Barton, Garry

AU - Turner, David

AU - Mee, Harry

AU - Gregson, Barbara A.

AU - Kolias, Angelos G.

AU - Turner, Carole

AU - Adams, Hadie

AU - Mohan, Midhun

AU - Uff, Christopher

AU - Hasan, Shumaila

AU - Wilson, Mark

AU - Bulters, Diederik Oliver

AU - Zolnourian, Ardalan

AU - McMahon, Catherine

AU - Stovell, Matthew G.

AU - Al-Tamimi, Yahia

AU - Thomson, Simon

AU - Viaroli, Edoardo

AU - Belli, Antonio

AU - King, Andrew

AU - Helmy, Adel E.

AU - Timofeev, Ivan

AU - Menon, David

AU - Hutchinson, Peter John

AU - For the RESCUE-ASDH Trial collaborators

N1 - Funding Information: No support from any organisation other than the National Institute for Health and Care Research was received for the submitted work. BAG has received consulting fees from Cambridge University Hospitals NHS Foundation Trust. AGK is supported by a Senior Lectureship at the School of Clinical Medicine, University of Cambridge, the Wellcome Trust, and the Royal College of Surgeons of England. MW has received support for attending meetings and/or travel for presentations with the Wilderness Medical Society and Royal College of Surgeons of Edinburgh, is a member of the Trauma Clinical Reference group for the NHS, meetings secretary for the Society of British Neurosurgeons and a non-salaried medical director of GoodSAM. PJH is supported by a Research professorship and Senior Investigator award from the NIHR, the NIHR Cambridge Biomedical Research Centre and the Royal College of Surgeons of England. Funding Information: This project was supported by the Health Technology Assessment (HTA) Programme (project number 12/35/57) and will be published in full in the HTA journal at https://fundingawards.nihr.ac.uk/award/12/35/57; The RESCUE-ASDH trial is an 'embedded study' linked with the CENTER-TBI project (https://www.center-tbi.eu/) of the European Brain Injury Consortium. CENTER-TBI was a large-scale collaborative project, supported by the FP7 Program of the European Union (grant number 602150); RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545. Study protocol is available at https://fundingawards.nihr.ac.uk/ award/12/35/57. We thank the patients who participated in the RESCUE-ASDH trial, their families, and all the collaborating clinicians and research staff, and we thank the staff of the Cambridge Clinical Trials Unit for their support. Publisher Copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

PY - 2024/6/16

Y1 - 2024/6/16

N2 - Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. Setting UK secondary care. Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). Trial registration number ISRCTN87370545.

AB - Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH). Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial. Setting UK secondary care. Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122). Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery). Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists. Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE. Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant). Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076). Trial registration number ISRCTN87370545.

KW - brain injuries

KW - health economics

KW - neurosurgery

KW - randomized controlled trial

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U2 - 10.1136/bmjopen-2024-085084

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JO - BMJ Open

JF - BMJ Open

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Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma

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