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Date
Jun
06
2006

Is More Aggressive Treatment of Severe Brain Injuries in Children Worth It?

Presenter:

Mick Tilford

Authors:

Mick Tilford, Allen Goodman, P. David Adelson

Chair: David Bishai; Discussant: TBA Tue June 6, 2006 10:45-12:15 Room 325

Rationale: Management of traumatic brain injury varies according to treatments and in terms of aggressiveness. Variations in treatment aggressiveness are related to concerns over poor outcomes in survivors. Data describing health outcomes of children following traumatic brain injury that can be used in economic evaluations is scant.

Objective: To provide information on preference scores of children who survived a severe traumatic brain injury and use this information to calculate incremental cost-effectiveness ratios.

Methods: Information on life years gained and acute care costs from longitudinal hospital studies were combined with follow-up data on survivors. Follow-up data was based on telephone interviews with the primary caregiver of surviving children. In addition to demographic and insurance information, caregivers of survivors described use of services following discharge from the acute care hospital and reported on health-related quality of life using the Quality of Well-being (QWB) scale. Cost-effectiveness ratios were formed from the QWB scores and costs of acute and rehabilitative care.

Results: Over a 12-year period, approximately 6,500 children survived a traumatic brain that otherwise would have expired without more aggressive treatment. Follow-up data at 3 and 6-months following hospital discharge indicated a range in preference scores from 0.093 to 1.0 with a mean of 0.507 (0.201) at 3 months and 0.579 (0.227) at 6 months. Scores were related to probabilities of dying at the time of hospital admission. Children lacking health insurance had higher probabilities of dying and worse outcomes. Cost per quality adjusted life year was approximately $12,000 for the mean preference score estimates and $67,000 for the worst scores.

Conclusions: This study suggests that aggressive treatment in children with traumatic brain injury is warranted. Future research should further examine rehabilitation service use of uninsured children in relation to injury severity and outcomes.

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