Measuring the cost-effectiveness of technologic change in the treatment of pediatric traumatic brain injury.

Substantial variation exists with respect to the management of traumatic brain injuries (TBI) in children. Centers that practice aggressive treatment of TBI may improve survival, but it is not clear that the outcomes can be justified using cost-effectiveness criteria. This study illustrates the use of cost-effectiveness analysis to assess interventions for improving outcomes in children by assessing the cost per quality-adjusted life year (QALY) gained from technological change in the treatment of TBI. Cost and survival data associated with technological change in the treatment of pediatric TBI was based on nationally representative hospital administrative data for all children <21 years with a TBI who required endotracheal intubation or mechanical ventilation. With QALYs of pediatric TBI survivors based on life expectancies ranging between 5 and 30 years and on an estimated preference score of approximately 0.5, the estimated incremental cost-effectiveness ratio ranges between $19,000 and $109,000 per QALY gained. Adding estimated rehabilitation costs increases the cost-effectiveness ratio to between $57,000 and $244,000 per QALY. Sensitivity analysis indicates that estimates of life years gained are critical to the estimated ratio. If TBI survivors live more than 5 years, then the estimated cost-effectiveness ratio seems favorable.