The preventive treatment of the unruptured intracranial aneurysm (UIA) is to avoid the morbidity and death associated with aneurysmal subarachnoid hemorrhage. There is no comparison between the conservative strategy and the surgical approach that combines endovascular therapy and microsurgical clipping. A study was done to undertake an updated cost-effectiveness analysis comparing the two treatments in patients with UIA. A Markov model was used to create a decision tree. Quality-adjusted life-years (QALYs) associated with living with UIA were obtained prospectively from a cohort of UIA patients at a tertiary center before and after treatment. They measured the outcomes in terms of QALYs. Sensitivity analyses were done to assess the model’s robustness and completed threshold analyses to investigate the impact of input parameters.
Treatment of UIAs as a preventative measure consistently resulted in higher utility. Endovascular treatment was more cost-effective in models with a higher share of it. Older cohort models were less cost-effective than younger cohort models. Treatment was cost-effective in several models based on the proportion of endovascular therapy and cohort age if the annual rupture risk exceeded a threshold between 0.8% and 1.9%. This threshold was lowered due to a higher proportion of endovascular procedures and younger age, making the treatment of aneurysms with a lower risk of rupture more cost-effective. Compared to conservative management, preventive therapy of aneurysms resulted in better utility. The most cost-effective models had a higher share of endovascular treatment and younger patients.
Reference:thejns.org/view/journals/j-neurosurg/135/6/article-p1608.xml
