Cost-efectiveness of intracraneal pressure monitoring in pediatric patients with severe traumatic brain injury: A simulation modeling approach

Abstract

To conduct an economic evaluation of intracranial pressure (ICP) monitoring on the basis of current evidence from pediatric patients with severe traumatic brain injury, through a statistical model.

Methods: The statistical model is a decision tree, whose branches take into account the severity of the lesion, the hospitalization costs, and the quality-adjusted life-year for the first 6 months post-trauma. The inputs consist of probability distributions calculated from a sample of 33 surviving children with severe traumatic brain injury, divided into two groups: with ICP monitoring (monitoring group) and without ICP monitoring (control group). The uncertainty of the parameters from the sample was quantified through a probabilistic sensitivity analysis using the Monte-Carlo simulation method. The model overcomes the drawbacks of small sample sizes, unequal groups, and the ethical difficulty in randomly assigning patients to a control group (without monitoring).

Results: The incremental cost in the monitoring group was Mex$3,934 (Mexican pesos), with an increase in quality-adjusted life-year of 0.05. The incremental costeffectiveness ratio was Mex$81,062. The cost-effectiveness acceptability curve had a maximum at 54% of the cost-effective iterations. The incremental net health benefit for a willingness to pay equal to 1 time the per capita gross domestic product for Mexico was 0.03, and the incremental net monetary benefit was Mex$5,358. Conclusions: The results of the model suggest that ICP monitoring is cost-effective because there was a monetary gain in terms of the incremental net monetary benefit.