The aggressive management of severe traumatic brain injury (TBI) involves expensive interventions such as intracranial monitoring and decompressive craniectomy.

     We set out to determine whether aggressive treatment of severe TBI is cost effective.

      

     A decision-analytic model was created to compare treatment strategies for severe TBI, which included (1) aggressive care (adherence to the Brain Trauma Foundation Guidelines in greater than 50% of cases), (2) routine care (adherence in less than 50% of cases), and (3) comfort care (aggressive care for one day, followed by non-ICU care). The probability of each treatment resulting in various Glasgow Outcome Scale scores was obtained from the literature and converted to quality-adjusted life years (QALYs) based on expected longevity and quality of life; costs were obtained from the perspective of society. We performed a sensitivity analysis and used the model to estimate values at various ages.

     For the average 20 year-old, aggressive care yielded 11.7 ±1.6 QALYs compared to routine care (10.0 ±1.5 QALYs) (p < 0.0001) and remained significantly better at all ages. Aggressive care was also significantly less costly than routine care ($1,264,000 ±118,000 vs. $1,361,000 ±107,000) up to age 80. Even in the 80 year-old, aggressive care was more cost-effective. Comfort care was associated with poorer outcomes at all ages and with higher costs for patients less than 80 years.

     This is a retrospective study.

     The aggressive treatment of severe TBI is a cost-effective treatment option, even for the elderly.

     Comfort care should be reserved for cases of failed treatment.