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

RESCUE-ASDH trial collaborators; 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

doi:10.1136/bmjopen-2024-085084

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

RESCUE-ASDH trial collaborators
, 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

^*Corresponding author for this work

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

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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
Pages (from-to)	e085084
Number of pages	10
Journal	BMJ Open
Volume	14
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2024-085084
Publication status	Published - 16 Jun 2024

Keywords

Adult
Aged
Female
Humans
Male
Middle Aged
Cost-Benefit Analysis
Craniotomy/economics
Decompressive Craniectomy/economics
Glasgow Outcome Scale
Hematoma, Subdural, Acute/surgery
Quality-Adjusted Life Years
Treatment Outcome
United Kingdom

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RESCUE-ASDH trial collaborators, 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., ... Hutchinson, P. J. (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

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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 = "Adult, Aged, Female, Humans, Male, Middle Aged, Cost-Benefit Analysis, Craniotomy/economics, Decompressive Craniectomy/economics, Glasgow Outcome Scale, Hematoma, Subdural, Acute/surgery, Quality-Adjusted Life Years, Treatment Outcome, United Kingdom",

author = "\{RESCUE-ASDH trial collaborators\} and 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\}",

year = "2024",

month = jun,

day = "16",

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

language = "English",

volume = "14",

pages = "e085084",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

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RESCUE-ASDH trial collaborators, 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 2024, 'Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma', BMJ Open, vol. 14, no. 6, pp. e085084. https://doi.org/10.1136/bmjopen-2024-085084

TY - JOUR

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

AU - RESCUE-ASDH trial collaborators

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

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 - Adult

KW - Aged

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Cost-Benefit Analysis

KW - Craniotomy/economics

KW - Decompressive Craniectomy/economics

KW - Glasgow Outcome Scale

KW - Hematoma, Subdural, Acute/surgery

KW - Quality-Adjusted Life Years

KW - Treatment Outcome

KW - United Kingdom

U2 - 10.1136/bmjopen-2024-085084

DO - 10.1136/bmjopen-2024-085084

M3 - Article

C2 - 38885989

SN - 2044-6055

VL - 14

SP - e085084

JO - BMJ Open

JF - BMJ Open

IS - 6

ER -

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

Abstract

Keywords

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