Objectives: It is not currently clear whether all anticoagulated patients with a head injury should
receive CT scanning or only those with evidence of traumatic brain injury (e.g. loss of consciousness
or amnesia). We aimed to determine the cost-effectiveness of CT for all compared to selective CT
use for anticoagulated patients with a head injury.
Design: Decision-analysis modelling of data from a multi-centre observational study.
Setting: 33 Emergency Departments in England and Scotland.
Participants: 3566 adults (aged ≥16 years) who had suffered blunt head injury, were taking warfarin
and underwent selective CT scanning.
Main outcome measures: Estimated expected benefits in terms of quality-adjusted life years
(QALYs) were the entire cohort to receive a CT scan; estimated increased costs of CT and also the
potential cost implications associated with patient survival and improved health. These values were
used to estimate the cost per QALY of implementing a strategy of CT for all patients compared to
observed practice based on guidelines recommending selective CT use.
Results: Of the 1420/3534 patients (40%) who did not receive a CT scan, 7 (0.5%) suffered a
potentially avoidable head injury related adverse outcome. If CT scanning had been performed in all
patients, appropriate treatment could have gained 3.41 additional quality-adjusted life years (QALYs)
but would have incurred £193,149 additional treatment costs and £130,683 additional CT costs. The
incremental cost-effectiveness ratio of £94,895/QALY gained for unselective compared to selective
CT use is markedly above the threshold of £20-30,000/QALY used by the UK National Institute for
Care Excellence to determine cost-effectiveness.
Conclusions: CT scanning for all anticoagulated patients with head injury is not cost-effective
compared with selective use of CT scanning based on guidelines recommending scanning only for
those with evidence of traumatic brain injury
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)