1379. Cost Effectiveness of Biomarker Screening for Traumatic Brain Injury

Authors: YouRong Sophie Su, MD; James Schuster, MD, PhD; Douglas Smith, MD; Sherman Stein, MD (Philadelphia, PA)

Introduction: Intracranial hemorrhage after traumatic brain injury (TBI) can be life threatening and requires prompt diagnosis. CT scans are a rapid way to evaluate for hemorrhage. However, in patients with mild/moderate TBI, in whom the incidence of hemorrhage is low, scanning every patient with CT can be costly. The FDA recently approved of a novel biomarker screen, the Banyan Trauma Indicator (BTI), to streamline the decision for CT scanning in mild to moderate TBI. Methods: Literature databases were searched in February 2018 for “head injury” with “mild” or “moderate” in the title. The search returned 3240 abstracts, 22 of which were used in analyses of the study. We abstracted estimates of the probability of intracranial lesions, the cost of a CT scan and the operating characteristics (sensitivity and specificity) of clinical screening tests and the BTI. We performed cost analyses of the BTI screen to determine the threshold of cost-effectiveness, compared to clinical decision rules or routine CT scans, for cases of mild or moderate TBI. Results: Our meta-analyses found the pooled mean probability that a mild TBI patient has an intracranial lesion is 0.104 (95% CI = 0.085 to 0.123). With a 0.104 probability, the biomarker screen is cost effective for mild TBI if the cost is $308.96 or below per test. In moderate TBI, because of the greater prevalence of intracranial lesions at 0.663 (95% CI = 0.492 to 0.834), there is a lower need for screening and BTI becomes cost-effective up to $73.41 per test. Conclusion: To curb the number of unnecessary head CTs performed, the FDA approved of the Banyan Trauma Indicator as a new blood screen to evaluate for the presence of an intracranial lesion. We hope this study can provide guidance on not only the implementation of the screen, but also the societal cost.