Cost-Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia

Dane Moran, Mark G. Shrime, Sam Nang, Iv Vycheth, Din Vuthy, Raksmey Hong, William V. Padula, Kee B. Park

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Epidural hematoma (EDH) is a common and potentially deadly occurrence following a severe traumatic brain injury. Our aim was to determine whether craniotomy is cost-effective when indicated for the treatment of EDH when a trained neurosurgeon is available. Methods: A decision tree was used to model the cost-effectiveness of craniotomy available versus craniotomy unavailable for the management of traumatic EDH from a Cambodian societal and provider perspective. Costs and effectiveness parameters were obtained from patient data at a large government hospital in Cambodia. Outcomes were measured in quality-adjusted life years (QALYs). Incremental cost per QALY and budget impact were calculated for each intervention at a willingness-to-pay (WTP) threshold of $9787.80/QALY (3× GDP per capita PPP). The time horizon reflected full life span, and costs and QALYs were discounted at 3%. Sensitivity analysis was also conducted. Results: Compared to craniotomy unavailable for EDH ($945.80; 11.78 QALYs), craniotomy available came at a higher cost and greater effectiveness ($1520.73; 12.78 QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $574.93. One-way analysis demonstrated that craniotomy unavailable became more cost-effective than craniotomy available when the percent chance of having a GOS of 4 or 5 was 60% for patients with an EDH where craniotomy was indicated but not performed. Probabilistic sensitivity analysis revealed that craniotomy available was more cost-effective than conservative management in 84.4% of simulations at the WTP threshold. Conclusions: Craniotomy is a cost-effective treatment for patients with a traumatic EDH who meet criteria for operation when trained neurosurgeons are available onsite.

Original languageEnglish (US)
Pages (from-to)2215-2223
Number of pages9
JournalWorld journal of surgery
Volume41
Issue number9
DOIs
StatePublished - Sep 1 2017

ASJC Scopus subject areas

  • Surgery

Fingerprint

Dive into the research topics of 'Cost-Effectiveness of Craniotomy for Epidural Hematomas at a Major Government Hospital in Cambodia'. Together they form a unique fingerprint.

Cite this