Mild head injury: observation or computed tomography? Economic aspects by literature review and decision analysis

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Abstract
Objectives: To compare the costs of two strategies for acute management of mild head injury: inhospital observation compared with acute computed tomography (CT) and home care. Methods: Studies comparing costs for the two strategies that seem to have similar outcomes for patients were systematically reviewed. A decision tree analysis to compare the costs was also constructed, based on Swedish national costs and the risks found in a recent review on mild head injury complications. Results: No studies were found that directly measured and compared risks, benefits, and costs of the two strategies. In the four studies retrieved, involving 4126 patients, the costs for hospital observation were factual, but a model was used to evaluate costs for the CT strategy. On average, costs were one third lower with CT. Also, the decision tree analysis demonstrated that the CT strategy was one third less expensive than inhospital observation. A sensitivity analysis showed this to be valid for nearly all cases. If these calculations hold true, a change of strategy could result in annual savings of £280 000/million inhabitants. Conclusion: The CT strategy seems to cost one third less than hospital observation.