Aggressive Care Improves QoL in Traumatic Brain Injury

Yields better outcomes and reduces costs, regardless of patient age

MONDAY, March 12 (HealthDay News) -- Compared with routine care, an aggressive-care approach to the treatment of patients with severe traumatic brain injury (TBI), which follows the Brain Trauma Foundation guidelines, is estimated to improve quality of life and significantly lower associated costs, regardless of patient age, according to research published online March 6 in the Journal of Neurosurgery.

Robert G. Whitmore, M.D., of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues used a decision-analytical model to compare costs, outcomes, and cost-effectiveness associated with an aggressive-care, a comfort-care, and a routine-care approach to the treatment of patients with severe TBI. Literature-based Glasgow Outcome Scale scores were converted to quality-adjusted life years (QALYs). Direct and indirect costs for patients aged 20, 40, 60, and 80 years were estimated using sensitivity analyses.

The researchers found that aggressive care of a 20-year-old patient with severe TBI was estimated to yield 11.7 more QALYs and cost less than routine care (average of $1,264,000 versus $1,361,000). While the difference in QALYs between the aggressive- and routine-care approaches decreased with advancing age, the aggressive-care approach was still deemed to be more cost-effective, up to age 80. Comfort care correlated with poorer outcomes and high costs in all except 80-year-olds.

"When all the costs of severe TBI are considered, aggressive treatment is cost-effective, even for older patients," the authors write.

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