Cervical Spine Screening with CT in Trauma Patients: A Cost-effectiveness Analysis

TLDR

The study investigates the cost‑effectiveness of CT versus radiography for cervical spine screening in trauma patients. A decision‑analysis model from a societal perspective compared CT and radiography across high, moderate, and low‑risk trauma cohorts, using literature‑derived probabilities and costs to estimate paralysis prevention, total screening costs, and incremental cost‑effectiveness ratios. CT screening is a dominant, cost‑effective strategy for high‑risk patients, cost‑effective for moderate‑risk patients, and while it prevents paralysis in low‑risk patients, its incremental cost‑effectiveness ratio exceeds $80,000/QALY, making it the preferred modality for high and moderate risk groups.

Abstract

To investigate the cost-effectiveness of computed tomography (CT) relative to radiography for cervical spine screening in trauma patients.A decision analysis model was constructed to compare the incremental cost-effectiveness of radiography and CT as primary cervical spine screening modalities in trauma patients. Analyses were performed from a societal perspective, and probability and cost estimates from the literature and institutional experience were used. In separate cost-effectiveness analyses, hypothetical cohorts of trauma patients from three defined clinical scenarios were considered: high, moderate, and low risk for cervical spine fracture. Outcome measures included cases of paralysis prevented, total cost of screening strategies, and incremental cost-effectiveness ratios.In high-risk patients, screening with CT is a dominant strategy that prevents cases of paralysis and saves money for society. In moderate-risk patients, screening with CT is cost-effective with reference-case assumptions and within the range of most sensitivity analyses. In the low-risk group, CT screening helps prevent cases of paralysis, but the incremental cost-effectiveness ratio is high (> $80,000 per quality-adjusted life year).CT is the preferred cervical spine screening modality in trauma patients at high and moderate risk for cervical spine fracture.