Cost-effectiveness of treatment of unruptured intracranial aneurysms in patients with a history of subarachnoid hemorrhage.
OBJECTIVE
The study goal was to evaluate the cost-effectiveness of surgery and endovascular treatment of unruptured intracranial aneurysms in patients with a history of subarachnoid hemorrhage from a previous aneurysm, incorporating the results of the prospective International Study of Unruptured Intracranial Aneurysms.


METHODS
Using a Markov model, we performed a decision and cost-effectiveness analysis comparing surgery or endovascular treatment with no treatment. Twelve clinical scenarios were defined based on aneurysm size and location. Probabilistic sensitivity analyses were performed for 50- and 40-year-old cohorts. Treatment was considered to be cost-effective at an incremental cost-effectiveness ratio less than $100,000 per quality-adjusted life-year.


RESULTS
In 50-year-old patients, no treatment was the most cost-effective strategy for aneurysms located in the cavernous carotid artery. For aneurysms less than 7 mm located in the anterior circulation, no treatment was the most cost-effective strategy. Endovascular treatment was the most cost-effective option for 7- to 24-mm aneurysms, whereas surgery was the most cost-effective option for aneurysms of 25 mm or larger. For aneurysms less than 7 mm and located in the posterior circulation, endovascular treatment was the most cost-effective option, whereas surgery was the most cost-effective option for 7- to 12-mm aneurysms. No treatment was the most cost-effective strategy for aneurysms of 13 mm or larger.


CONCLUSIONS
For 50-year-old patients with a history of aneurysmal subarachnoid hemorrhage, treatment of unruptured aneurysms that are located in the cavernous carotid artery, or small (<7 mm) and located in the anterior circulation, or large (>or=13 mm) and located in the posterior circulation is ineffective or not cost-effective.
Takao
Hidemasa
H
Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. takaoh-tky@umin.ac.jp
Nojo
Takeshi
T
Ohtomo
Kuni
K
D000328:Adult; D003362:Cost-Benefit Analysis; D006801:Humans; D002532:Intracranial Aneurysm / Q000191:economics / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008390:Markov Chains; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome