Abdullah, Mazlan
(2005)
Cost effectiveness study of using different monitoring modalities in treating severe traumatic brain injury (CESTBI).
Cost effectiveness study of using different monitoring modalities in treating severe traumatic brain injury (CESTBI).
(Submitted)
Abstract
Introduction:
Injuries are the major causes of death and disability. In Malaysia, injury remains the
third leading cause of admission and death in government hospitals. There are two schools of thought in practicing neurotrauma monitoring for patients with severe
traumatic brain injury (TBI); the application of the basel~e neuro-monitoring (BNM)
and the use of multiple modalities neurotrauma monitoring (M3) which is very
expensive. The answer of which of the two monitoring systems is more effective
should be sought.
Objective:
To determine the cost effectiveness of BNM and M3 monitoring modalities in the
management of severe TBI in Hospital USM (HUSM), Kelantan
Methodology:
Sixty-two patients with severe TBI admitted to Neuro-ICU, HUSM who fulfilled the
predetermined criteria were purposely selected and grouped according to the
surgeon's on call list. The macro and micro costing were performed on each of
patient. Barthel Index was used to measure physical performance as an outcome six
months after discharge. The equality of the two study groups i.e M3 and BNM, was
analyzed by using independent t- test and chi square test, ANCOV A was used to
analyze the different in mean total equipment cost between the group ofM3 and BNM
by controlling the covariate like age and severity of brain injury, and Repeated
Measure ANOVA was used to look for any significant changes in the mean of Barthel
Index between the group of M3 and BNM during admission and six months post
discharge. ~
Results:
The mean total equipment cost of M3 was significantly higher than mean total
equipment cost ofBNM at p = 0.049 (mean difference ofRM23.74) after controlling
other' variables. The mean difference in Barthel Index after six months was significant
between the two groups (p = 0.031), patients who were treated with M3 had higher
score [63.7 (SD 30.03)] compared to those who were treated with BNM [46.83 (SD
30.36)]. However, the cost-effectiveness ratio of using. M3 was significantly lower
(p~0.031) with a mean ofRM476.29 needed for a unit improvement in mean Barthel
Index compared to RM629.12 if we used BNM
Conclusion:
Although M3 is more costly, the outcome of patients treated with M3 was better than
BNM. Therefore we can conclude that the used of multiple neuro-monitoring was
more cost effective than the use of only baseline neuro-monitoring in treating severe
traumatic brain injury.
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