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

doi:10.1093/bjs/znaa091

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 journal › Article › Academic › peer-review

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Abstract

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 language	English
Pages (from-to)	277-285
Number of pages	9
Journal	British Journal of Surgery
Volume	108
Issue number	3
DOIs	https://doi.org/10.1093/bjs/znaa091
Publication status	Published - Mar 2021

Bibliographical note

Acknowledgements
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.

Publisher Copyright: © 2021 John Wiley and Sons Ltd. All rights reserved.

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Treskes, K., Sierink, J. C., REACT-2 study group, Edwards, M. J. R., Beuker, B. J. A., Van Lieshout, E. M. M., Hohmann, J., Saltzherr, T. P., Hollmann, M. W., Van Dieren, S., Goslings, J. C., & Dijkgraaf, M. G. W. (2021). Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial). British Journal of Surgery, 108(3), 277-285. https://doi.org/10.1093/bjs/znaa091

@article{4b595a892773468d9558306d4e12911d,

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

abstract = "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.",

author = "K. Treskes and Sierink, {J. C.} and {REACT-2 study group} and Edwards, {M. J.R.} and Beuker, {B. J.A.} and {Van Lieshout}, {E. M.M.} and J. Hohmann and Saltzherr, {T. P.} and Hollmann, {M. W.} and {Van Dieren}, S. and Goslings, {J. C.} and Dijkgraaf, {M. G.W.} and Luitse, {J. S.} and T. Schepers and Beenen, {L. F.M.} and Tromp, {T. N.} and M. Brink and {El Moumni}, M. and Harbers, {J. S.} and P. Patka and {Den Hartog}, D. and T. Hagenaars",

note = "Acknowledgements 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. Publisher Copyright: {\textcopyright} 2021 John Wiley and Sons Ltd. All rights reserved.",

year = "2021",

month = mar,

doi = "10.1093/bjs/znaa091",

language = "English",

volume = "108",

pages = "277--285",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "John Wiley & Sons Ltd.",

number = "3",

}

Treskes, K, Sierink, JC, REACT-2 study group, Edwards, MJR, Beuker, BJA, Van Lieshout, EMM, Hohmann, J, Saltzherr, TP, Hollmann, MW, Van Dieren, S, Goslings, JC & Dijkgraaf, MGW 2021, 'Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial)', British Journal of Surgery, vol. 108, no. 3, pp. 277-285. https://doi.org/10.1093/bjs/znaa091

TY - JOUR

T1 - Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial)

AU - Treskes, K.

AU - Sierink, J. C.

AU - REACT-2 study group

AU - Edwards, M. J.R.

AU - Beuker, B. J.A.

AU - Van Lieshout, E. M.M.

AU - Hohmann, J.

AU - Saltzherr, T. P.

AU - Hollmann, M. W.

AU - Van Dieren, S.

AU - Goslings, J. C.

AU - Dijkgraaf, M. G.W.

AU - Luitse, J. S.

AU - Schepers, T.

AU - Beenen, L. F.M.

AU - Tromp, T. N.

AU - Brink, M.

AU - El Moumni, M.

AU - Harbers, J. S.

AU - Patka, P.

AU - Den Hartog, D.

AU - Hagenaars, T.

N1 - Acknowledgements 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. Publisher Copyright: © 2021 John Wiley and Sons Ltd. All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - 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.

AB - 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.

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DO - 10.1093/bjs/znaa091

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AN - SCOPUS:85106068747

SN - 0007-1323

VL - 108

SP - 277

EP - 285

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 3

ER -

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

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