Title : A cost utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage
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).
Audience Take away
- The audience will learn how we conducted a cost-utility analysis on the two main surgical treatments for a subarachnoid haemorrhage – endovascular coiling and neurosurgical clipping. This would be useful for audience members hoping to expand their skills in conducting research studies and teaching others – and thus would be relevant to all faculties of medicine
- The audience will learn which treatment proved to possess more utility for its cost, and how this fits in with NICE’s willingness-to-pay thresholds. This can help audience members better understand the utility of these interventions and the future of their usage in the NHS, which can be relevant for doctors that practice them
- The audience will learn about the common clinical outcomes and complications relevant to the two surgical treatments. This would be helpful for all audience members interested in neurology and neurosurgery as these factors greatly contribute to the overall quality of future care provided to their patients
- The audience will learn and be updated on relevant current literature on both interventions, covering previous large-scale studies and a cost effectiveness analysis
