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Emergency Radiology |
1 From the Department of Radiology, University of North Carolina–Chapel Hill School of Medicine, CB #7510, 508 Old Infirmary Bldg, Chapel Hill, NC 27599-7510 (C.C.B.), and the Robert Wood Johnson Clinical Scholars Program (C.C.B., R.A.D.), Department of Radiology, Harborview Medical Center (C.C.B., F.A.M.), and Department of Medicine (S.D.R., R.A.D.), University of Washington School of Medicine, Seattle. Received December 23, 1997; revision requested March 23, 1998; final revision received November 23; accepted January 8, 1999. C.C.B. supported by the Seattle Veterans Affairs Medical Center-Robert Wood Johnson Clinical Scholars Program. Address reprint requests to C.C.B., Department of Radiology, Harborview Medical Center, Box 359728, 325 Ninth Ave, Seattle, WA 98104-2499.
PURPOSE: To investigate the cost-effectiveness of computed tomography (CT) relative to radiography for cervical spine screening in trauma patients.
MATERIALS AND METHODS: A decision analysis model was constructed to compare the incremental cost-effectiveness of radiography and CT as primary cervical spine screening modalities in trauma patients. Analyses were performed from a societal perspective, and probability and cost estimates from the literature and institutional experience were used. In separate cost-effectiveness analyses, hypothetical cohorts of trauma patients from three defined clinical scenarios were considered: high, moderate, and low risk for cervical spine fracture. Outcome measures included cases of paralysis prevented, total cost of screening strategies, and incremental cost-effectiveness ratios.
RESULTS: In high-risk patients, screening with CT is a dominant strategy that prevents cases of paralysis and saves money for society. In moderate-risk patients, screening with CT is cost-effective with reference-case assumptions and within the range of most sensitivity analyses. In the low-risk group, CT screening helps prevent cases of paralysis, but the incremental cost-effectiveness ratio is high (>$80,000 per quality-adjusted life year).
CONCLUSION: CT is the preferred cervical spine screening modality in trauma patients at high and moderate risk for cervical spine fracture.
Index terms: Cost-effectiveness • CT, helical, 31.12115 • Spine, CT, 31.12115 • Spine, fractures, 31.41 • Trauma
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