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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).
METHODS: 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.
METHODS: UK secondary care.
METHODS: 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).
METHODS: Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).
METHODS: 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).
METHODS: 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).
BACKGROUND: ISRCTN87370545.
METHODS: 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.
METHODS: UK secondary care.
METHODS: 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).
METHODS: Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).
METHODS: 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).
METHODS: 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).
BACKGROUND: ISRCTN87370545.
摘要：
目的：评估开颅手术的成本效益，在接受急性硬膜下血肿（ASDH）撤离的英国患者中，与去骨瓣减压术（DC）进行了比较。
方法：使用来自12个月多中心的卫生资源使用和结果数据进行经济评估，务实,平行组，随机化，接受撤离-ASDH试验的患者的颅骨切除术的随机评估。
方法：英国二级保健。
方法：248例接受外伤性ASDH手术的UK患者被随机分为开颅手术（N=126）或DC（N=122）。
方法：通过开颅手术（替换骨瓣）或DC（保留骨瓣，以便以后替换：颅骨成形术）进行手术疏散。
方法：在基本案例分析中，费用是从国家卫生服务和个人社会服务的角度估计的。通过EuroQoL5维5级问卷（成本效用分析）和格拉斯哥扩展结果量表（GOSE）（成本效益分析）得出的质量调整生命年（QALY）评估结果。进行了多重插补和回归分析，以估计开颅手术与DC相比的平均增量成本和效果。选择了最具成本效益的方案,无论经济学家认为的统计显著性水平如何。
结果：在成本效用分析中，与DC相比,开颅手术的平均增量成本估计为-5520英镑(95%CI-£18060~£7020),平均QALY增益为0.093(95%CI0.029~0.156).在成本效益分析中，平均增量成本估计为-4536英镑(95%CI-17374英镑至8301英镑),对于GOSE的有利结果,OR为1.682英镑(95%CI0.995至2.842).
结论：在患有创伤性ASDH的英国人群中，与DC相比，开颅手术估计具有成本效益：开颅手术估计平均成本较低，更高的平均QALY增益和更高的对GOSE更有利的结果的可能性(尽管并非两种方法之间的所有估计差异都具有统计学意义).
方法：该试验的伦理批准于2014年7月17日从英国西北海多克研究伦理委员会获得(14/NW/1076)。
背景：ISRCTN87370545。
方法：使用来自12个月多中心的卫生资源使用和结果数据进行经济评估，务实,平行组，随机化，接受撤离-ASDH试验的患者的颅骨切除术的随机评估。
方法：英国二级保健。
方法：248例接受外伤性ASDH手术的UK患者被随机分为开颅手术（N=126）或DC（N=122）。
方法：通过开颅手术（替换骨瓣）或DC（保留骨瓣，以便以后替换：颅骨成形术）进行手术疏散。
方法：在基本案例分析中，费用是从国家卫生服务和个人社会服务的角度估计的。通过EuroQoL5维5级问卷（成本效用分析）和格拉斯哥扩展结果量表（GOSE）（成本效益分析）得出的质量调整生命年（QALY）评估结果。进行了多重插补和回归分析，以估计开颅手术与DC相比的平均增量成本和效果。选择了最具成本效益的方案,无论经济学家认为的统计显著性水平如何。
结果：在成本效用分析中，与DC相比,开颅手术的平均增量成本估计为-5520英镑(95%CI-£18060~£7020),平均QALY增益为0.093(95%CI0.029~0.156).在成本效益分析中，平均增量成本估计为-4536英镑(95%CI-17374英镑至8301英镑),对于GOSE的有利结果,OR为1.682英镑(95%CI0.995至2.842).
结论：在患有创伤性ASDH的英国人群中，与DC相比，开颅手术估计具有成本效益：开颅手术估计平均成本较低，更高的平均QALY增益和更高的对GOSE更有利的结果的可能性(尽管并非两种方法之间的所有估计差异都具有统计学意义).
方法：该试验的伦理批准于2014年7月17日从英国西北海多克研究伦理委员会获得(14/NW/1076)。
背景：ISRCTN87370545。
