A Cost-Effectiveness Analysis Comparing Clinical Decision Rules PECARN, CATCH, and CHALICE With Usual Care for the Management of Pediatric Head Injury - 26/04/19
, Laura Fanning, MPH a, Meredith L. Borland, MBBS d, Natalie Phillips, MBBS e, Amit Kochar, MD f, Sarah Dalton, BMed g, Jeremy Furyk, MBBS i, Jocelyn Neutze, MBChB j, Stuart R. Dalziel, PhD k, Mark D. Lyttle, MBChB l, n, Silvia Bressan, PhD m, n, Susan Donath, MA b, n, Charlotte Molesworth, MBiostat c, Stephen J.C. Hearps, PGD n, Ed Oakley, MBBS b, c, n, Franz E. Babl, MD b, c, nfor the
Pediatric Research in Emergency Departments International Collaborative (PREDICT)
Abstract |
Study objective |
To determine the cost-effectiveness of 3 clinical decision rules in comparison to Australian and New Zealand usual care: the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), the Pediatric Emergency Care Applied Research Network (PECARN), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH).
Methods |
A decision analytic model was constructed from the Australian health care system perspective to compare costs and outcomes of the 3 clinical decision rules compared with Australian and New Zealand usual care. The study involved multicenter recruitment from 10 Australian and New Zealand hospitals; recruitment was based on the Australian Pediatric Head Injury Rules Study involving 18,913 children younger than 18 years and with a head injury, and with Glasgow Coma Scale score 13 to 15 on presentation to emergency departments (EDs). We determined the cost-effectiveness of the 3 clinical decision rules compared with usual care.
Results |
Usual care, CHALICE, PECARN, and CATCH strategies cost on average AUD $6,390, $6,423, $6,433, and $6,457 per patient, respectively. Usual care was more effective and less costly than all other strategies and is therefore the dominant strategy. Probabilistic sensitivity analyses showed that when simulated 1,000 times, usual care dominated all clinical decision rules in 61%, 62%, and 60% of simulations (CHALICE, PECARN, and CATCH, respectively). The difference in cost between all rules was less than $36 (95% confidence interval –$7 to $77) and the difference in quality-adjusted life-years was less than 0.00097 (95% confidence interval 0.0015 to 0.00044). Results remained robust under sensitivity analyses.
Conclusion |
This evaluation demonstrated that the 3 published international pediatric head injury clinical decision rules were not more cost-effective than usual care in Australian and New Zealand tertiary EDs. Understanding the usual care context and the likely cost-effectiveness is useful before investing in implementation of clinical decision rules or incorporation into a guideline.
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| Please see page 430 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: KD and JAC conceived the cost-effectiveness evaluation and supervised the conduct of the evaluation. KD, JAC, and LF designed the evaluation and conducted it, including collection of model parameters, and drafted the article. FEB obtained research funding and conceived the original Australasian Pediatric Head Injury Rules Study (APHIRST) study. JAC, MLB, NP, AK, S. Dalton, JF, JN, SRD, MDL, SB, EO, and FEB conducted the original APHIRST study and coordinated the collection of the data that inform this evaluation. S. Donath, CM, and SJCH provided statistical advice on data analysis. All authors contributed substantially to article revision. KD, JAC, and LF contributed equally take responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The study was funded by grants from the National Health and Medical Research Council (project grant GNT1046727, Centre of Research Excellence for Pediatric Emergency Medicine GNT1058560), Canberra, Australia; the Murdoch Children’s Research Institute, Melbourne, Australia; the Emergency Medicine Foundation (EMPJ-11162), Brisbane, Australia; Perpetual Philanthropic Services (2012/1140), Australia; Auckland Medical Research Foundation (No. 3112011) and the A + Trust (Auckland District Health Board), Auckland, New Zealand; WA Health Targeted Research Funds 2013, Perth, Australia; and the Townsville Hospital and Health Service Private Practice Research and Education Trust Fund, Townsville, Australia; and was supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. Dr. Babl’s time was partly funded by a grant from the Royal Children’s Hospital Foundation, Melbourne, Australia; a National Health and Medcial Research Council Practitioner Fellowship, Canberra, Australia; and The Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia. Dr. S. R. Dalziel’s time was partly funded by the Health Research Council of New Zealand (HRC13/556). |
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| Trial registration number: ACTRN12614000463673 |
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Vol 73 - N° 5
P. 429-439 - mai 2019 Retour au numéro
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- Dustin W. Ballard, Nathan Kuppermann, David R. Vinson, Eric Tham, Jeff M. Hoffman, Marguerite Swietlik, Sara J. Deakyne Davies, Evaline A. Alessandrini, Leah Tzimenatos, Lalit Bajaj, Dustin G. Mark, Steve R. Offerman, Uli K. Chettipally, Marilyn D. Paterno, Molly H. Schaeffer, Rachel Richards, T. Charles Casper, Howard S. Goldberg, Robert W. Grundmeier, Peter S. Dayan, Pediatric Emergency Care Applied Research Network (PECARN), Clinical Research on Emergency Services and Treatment (CREST) Network, Partners HealthCare
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