BMJ Open (Jun 2024)

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

  • Emma Toman,
  • David K Menon,
  • Antonio Belli,
  • Sridevi Nagarajan,
  • Julie Woodfield,
  • Ruichong Ma,
  • Jason J Chang,
  • Jonathan Cook,
  • Mark Kotter,
  • Vin Shen Ban,
  • Martin Smith,
  • John D Pickard,
  • Diederik Bulters,
  • Giles Critchley,
  • Damian Holliman,
  • Nicole Keong,
  • Andrew King,
  • Catherine McMahon,
  • Carole Turner,
  • Peter Whitfield,
  • Mark Wilson,
  • Melvin Stone,
  • Paul Brennan,
  • David Turner,
  • Garry Barton,
  • Rasheed Zakaria,
  • Angelos G Kolias,
  • Simon Shaw,
  • Sean Christie,
  • Dmitri Shastin,
  • Allison Hirst,
  • Soumya Mukherjee,
  • Gareth Roberts,
  • Simon Thomson,
  • Peter J Hutchinson,
  • Alexis Joannides,
  • Emanuel Cirstea,
  • Ashish Bindra,
  • Vairavan Narayanan,
  • David Menon,
  • Francesca Hill,
  • Ashwin Kumaria,
  • Franco Servadei,
  • Rhys Thomas,
  • Midhun Mohan,
  • Silvia Tarantino,
  • Ioana Moldovan,
  • Sara Venturini,
  • Tariq Khan,
  • Marianne Hare,
  • Louise Young,
  • Joan Grieve,
  • Ardalan Zolnourian,
  • Paula Carroll,
  • Diederik Oliver Bulters,
  • Mathew Guilfoyle,
  • Lisa Julien,
  • Barbara Gregson,
  • Martin Hunn,
  • Richard Nelson,
  • Stuart Smith,
  • Shahid Khan,
  • András Büki,
  • Deepak Gupta,
  • Christos Tolias,
  • David A Turner,
  • Christopher Madden,
  • Paul Johnston,
  • Peter John Hutchinson,
  • Patrick Holton,
  • Panagiota Gkolia,
  • Nicola Owen,
  • Kesava Reddy,
  • Hani Marcus,
  • Ibrahim Jalloh,
  • Shabin Joshi,
  • Ian Anderson,
  • Himanshu Shekhar,
  • Daniel Holsgrove,
  • Erin Lewis,
  • Tracey Moore,
  • Marios C Papadopoulos,
  • Paula Kareclas,
  • Peter Kirkpatrick,
  • Laura Parker,
  • Martina Stippler,
  • Sarah Pyne,
  • Peter J Kirkpatrick,
  • James Piercy,
  • Neil Davidson,
  • Prasanna Epaliyanage,
  • Barbara A Gregson,
  • Christopher Uff,
  • Malik Zaben,
  • Charlotte Eglinton,
  • Linetty Makawa,
  • Jane Perez,
  • Louise Harrison,
  • Mutwakil Abdulla,
  • Garry R Barton,
  • Mathew Joseph,
  • Anthony Bell,
  • Sarah Trippier,
  • Michael Canty,
  • Jonathan Pollock,
  • Manjul Tripathi,
  • Harry Mee,
  • Ivan Timofeev,
  • Ellie Edlmann,
  • Nadia Scantlebury,
  • Joseph Frantzias,
  • Yahia Al-Tamimi,
  • Kismet Hossain-Ibrahim,
  • Ciaran Hill,
  • Elisa Visentin,
  • Sonia Raj,
  • Ioannis Fouyas,
  • Siobhan Kearney,
  • Karen Caldwell,
  • Tamara Tajsic,
  • Belinda Gunning,
  • Emma Clarkson,
  • Manjunath Prasad,
  • Mary Kambafwile,
  • Tim Lawrence,
  • Emily Galea,
  • Sebastian Ille,
  • Hadie Adams,
  • Shumaila Hasan,
  • Matthew G Stovell,
  • Edoardo Viaroli,
  • Adel E Helmy,
  • Ivan S Timofeev,
  • Kirsty Grieve,
  • Liz Corteen,
  • Janet Corn,
  • Mohammad Naushahi,
  • Richard Mair,
  • Kamila Walker,
  • Selma Tülü,
  • Chipo Chitsenega,
  • Geetha Boyapati,
  • Muhammad Bhatti,
  • Natalia Ermalai,
  • Joseph Merola Liudmila,
  • Laurence Glanz,
  • Lani Patterson,
  • Colin Bergin,
  • Maximina Ventura,
  • Laura Ortiz-Ruiz de Gordoa,
  • Husam Georges,
  • Sam Jeffrey,
  • Natasha Wilmhurst,
  • Philip Kane,
  • Geraint Sunderland,
  • John Kitchen,
  • Mathew JosephMathew JosephGallagher,
  • Sonia Fernandez Lopez,
  • Andrea D’Mello,
  • Jo-Anna Conyngham,
  • Miriam Taylor,
  • Charlaine Reeve,
  • Vasileios Arzoglou,
  • Arif Zafar,
  • Efosa Ukponmwan,
  • Anastasios Giamouriadis,
  • Adam Wahba,
  • Patrick Easton,
  • Rose Clegg,
  • Grace Cole,
  • Louise Finlay,
  • Alex Leggate,
  • Terrie-Louise Cromie,
  • Javier Magan Ventura,
  • Ruth Womer,
  • Beverley Fulkner,
  • Geraldine Ward,
  • Kareen Damley,
  • Emma Fleming,
  • Roddy O’Kane,
  • Indira Devi Bhagavatula,
  • Dhananjaya Ishwar Bhat,
  • Dhaval Prem Shukla,
  • Kanti Konar,
  • Nagesh Shanhag,
  • Vaishali Nl Valluri,
  • Manoj Kumar Tewari,
  • Kaveri Sharma,
  • Christine Lock,
  • Chen Min Wei,
  • Julian Han,
  • Janell Kwok,
  • Nicolas Kon,
  • Kam King,
  • Emmalin Nelton,
  • Louis Anthony Whitworth,
  • Sonja Stutzman,
  • Caryn Harper,
  • Alice Salazar,
  • Rocco Armonda,
  • George B Moses,
  • Patricia Tanjucto,
  • Jamie Ullman,
  • Orseola Arapi,
  • Betsy Moclair,
  • Nrupen Baxi,
  • John Adair Prall,
  • Meghan Baldwin,
  • Jamie Jones,
  • Clare Gallagher,
  • Ish Bains,
  • Leodante Da Costa,
  • Fahad Alkherayf,
  • Rafael Ochoa Sanchez,
  • Kostas Fountas,
  • Thanasis Paschalis,
  • Sandro Krieg,
  • Maria Luisa,
  • Gandia Gomez,
  • Alfonso Legares,
  • Ana Maria Castaño Leon,
  • Gábor Lenzsér,
  • Mukhtar Khan,
  • Massimo Tomei,
  • Ronie Romelean Jayapalan,
  • Sarah C Pyne,
  • A David Mendelow,
  • Christopher Cowie,
  • Carol Davis-Wilkie,
  • Tapiwa Tungamirai,
  • Kerstin Wolf,
  • Natalia Igosheva,
  • Alicia Gore,
  • Michele Jillings,
  • Christopher Bushell,
  • Peter McCabe

DOI
https://doi.org/10.1136/bmjopen-2024-085084
Journal volume & issue
Vol. 14, no. 6

Abstract

Read online

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.