Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial)

K. Treskes*, J. C. Sierink, REACT-2 study group, M. J.R. Edwards, B. J.A. Beuker, E. M.M. Van Lieshout, J. Hohmann, T. P. Saltzherr, M. W. Hollmann, S. Van Dieren, J. C. Goslings, M. G.W. Dijkgraaf

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation. Methods: In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive. Results: A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were e25 809 (95 per cent bias-corrected and accelerated (bca) c.i. e22 617 to 29 137) for the iTBCT group and 26 155 (23 050 to 29 344) for the STWU group, a difference per patient in favour of iTBCT of 346 (4987 to 4328) (P=0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference-5.1 per cent; P=0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9). Conclusion: Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.

Original languageEnglish
Pages (from-to)277-285
Number of pages9
JournalBritish Journal of Surgery
Issue number3
Publication statusPublished - Mar 2021

Bibliographical note

The authors thank the following institutions and persons: ZonMw, the Netherlands Organization for Health Research and Development, for providing an unrestricted grant for the REACT-2 trial (ZonMw grant number 171102023); G. P. Clerx, T. N. Tromp, B. Bos, E. Baard, B. Visser, C. Bathelt and S. Purschke, research nurses at the participating sites, for their efforts in including patients and data completion; J. C. J. Noordegraaf, R. Siemons, C. van Ooijen, H. C. R. Nanninga, H. Hollander, B. J. Ponit, P. van Moorsel and L. van Moorsel, for gathering data on healthcare volume; M. J. A. M. Russchen and M. R. Wirtz, research students, for their assistance in data completion.

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