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Ahmed A, Ahmed Y, Duah-Asante K, Lawal A, Mohiaddin Z, Nawab H, Tang A, Wang B, Miller G, Malawana J. A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage. Neurosurg Rev 2022; 45:3259-3269. [PMID: 36056977 PMCID: PMC9492573 DOI: 10.1007/s10143-022-01854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
Endovascular coiling (EC) has been identified in systematic reviews and meta-analyses to produce more favourable clinical outcomes in comparison to neurosurgical clipping (NC) when surgically treating a subarachnoid haemorrhage from a ruptured aneurysm. Cost-effectiveness analyses between both interventions have been done, but no cost-utility analysis has yet been published. This systematic review aims to perform an economic analysis of the relative utility outcomes and costs from both treatments in the UK. A cost-utility analysis was performed from the perspective of the National Health Service (NHS), over a 1-year analytic horizon. Outcomes were obtained from the randomised International Subarachnoid Aneurysm Trial (ISAT) and measured in terms of the patient's modified Rankin scale (mRS) grade, a 6-point disability scale that aims to quantify a patient's functional outcome following a stroke. The mRS score was weighted against the Euro-QoL 5-dimension (EQ-5D), with each state assigned a weighted utility value which was then converted into quality-adjusted life years (QALYs). A sensitivity analysis using different utility dimensions was performed to identify any variation in incremental cost-effectiveness ratio (ICER) if different input variables were used. Costs were measured in pounds sterling (£) and discounted by 3.5% to 2020/2021 prices. The cost-utility analysis showed an ICER of - £144,004 incurred for every QALY gained when EC was utilised over NC. At NICE's upper willingness-to-pay (WTP) threshold of £30,000, EC offered a monetary net benefit (MNB) of £7934.63 and health net benefit (HNB) of 0.264 higher than NC. At NICE's lower WTP threshold of £20,000, EC offered an MNB of £7478.63 and HNB of 0.374 higher than NC. EC was found to be more 'cost-effective' than NC, with an ICER in the bottom right quadrant of the cost-effectiveness plane-indicating that it offers greater benefits at lower costs. This is supported by the ICER being below the NICE's threshold of £20,000-£30,000 per QALY, and both MNB and HNB having positive values (> 0).
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Affiliation(s)
- Ayla Ahmed
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Yonis Ahmed
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Kwaku Duah-Asante
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Abayomi Lawal
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Zain Mohiaddin
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Hasan Nawab
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Alexis Tang
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Imperial College Healthcare Trust, London, UK.
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK.
| | - George Miller
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK
| | - Johann Malawana
- Centre for Digital Health and Education Research, School of Medicine, University of Central Lancashire, Preston, UK
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