NICE

Oz Bloke's comments on a previous post led me to dig up this article evaluating the NICE head injury guidelines.

I reproduce the Result and Conclusion:


Result: 1130 patients with head injury were studied in four 1 month periods (two in each centre). At the teaching hospital, the CT head scan rate more than doubled (3% to 7%), the SXR declined (37% to 4%), while the admission rate more than halved (9% to 4%). This represented a saving of £3381 per 100 head injury patients: greater than predicted with no adverse events. At the District General Hospital, the CT head scan rate more than quadrupled (1.4% to 9%), the SXR dropped (19 to 0.57%), while the admission rate declined (7% to 5%). This represented a saving of £290 per 100 head injury patients: less than predicted.

Conclusion: The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes.


I once asked a senior why we did not practise the same protocol in our hospital. He told me that the savings in the study was due to the high inpatient costs in the countries studied; locally, in view of the lower ward charges compared to the cost of a CT scan, it was still more cost-effective to admit and observe the patients.

I'm not sure how true that was or is now, but I thought this was a good illustration of how economics affect clinical practices.