Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Jun 16;14(6):e085084.
doi: 10.1136/bmjopen-2024-085084.

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

Sarah Pyne  1 , Garry Barton  2 , David Turner  1 , Harry Mee  3 , Barbara A Gregson  4 , Angelos G Kolias  3   5 , Carole Turner  3   5 , Hadie Adams  3   5 , Midhun Mohan  3   5 , Christopher Uff  6 , Shumaila Hasan  6 , Mark Wilson  7 , Diederik Oliver Bulters  8 , Ardalan Zolnourian  8 , Catherine McMahon  9 , Matthew G Stovell  3 , Yahia Al-Tamimi  10   11 , Simon Thomson  12 , Edoardo Viaroli  3   5 , Antonio Belli  13 , Andrew King  14 , Adel E Helmy  3   5 , Ivan Timofeev  3   5 , David Menon  15 , Peter John Hutchinson  3   5 ; RESCUE-ASDH trial collaborators
Collaborators, Affiliations
Comparative Study

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

Sarah Pyne et al. BMJ Open. .

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: 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.

Similar articles

See all similar articles

References

    1. Parsonage M. Traumatic brain injury and offending. an economic analysis. 2016.
    1. Wilberger JE, Harris M, Diamond DL. Acute Subdural Hematoma: morbidity, mortality, and operative timing. J Neurosurg 1991;74:212–8. 10.3171/jns.1991.74.2.0212 - DOI - PubMed
    1. Phan K, Moore JM, Griessenauer C, et al. . Craniotomy versus Decompressive Craniectomy for acute Subdural Hematoma: systematic review and meta-analysis. World Neurosurgery 2017;101:677–85. 10.1016/j.wneu.2017.03.024 - DOI - PubMed
    1. NICE . NICE health technology evaluations: the manual (PMG 36). 2022.
    1. Hutchinson PJ, Adams H, Mohan M, et al. . Decompressive Craniectomy versus Craniotomy for acute Subdural Hematoma. N Engl J Med 2023;388:2219–29. 10.1056/NEJMoa2214172 - DOI - PubMed

Publication types

Associated data

LinkOut - more resources