Research Article
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Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms

Year 2022, Volume: 6 Issue: 1, 189 - 198, 27.01.2022
https://doi.org/10.30621/jbachs.1013502

Abstract

Background and aim: The study aims to assess the cost-effectiveness of endovascular coiling and surgical clipping in the treatment of unruptured cerebral aneurysms.
Materials and methods: Patients with ICD 10 I67.1 and treated with one of the two treatment methods performed at the Hacettepe University Hospitals between January 2013 and December 2015 were included in the study. The cost data in the study were obtained by analyzing patient invoices through the automation program of the university hospital. The effectiveness and treatment costs were assessed using the Markov model with the Social Security Institution’s (SSI) perspective. To generate the cost input in the model, the lifetime costs obtained based on the expert’s opinions were added to the amounts received from patient invoices.
Results: The study results were presented as the incremental cost-effectiveness ratio (ICER). When 3% reduction rate was applied to the costs and effectiveness data, the Quality Adjusted Life Years (QALY) was calculated as 4.39 and 1.84 for the coiling and clipping methods, respectively. Lifetime costs were 66463.40$ and 7900.27$ for the coiling and clipping methods, respectively. The incremental cost-effectiveness rate of endovascular coiling method was 22965.93.
Conclusion: The endovascular coiling method was found to be cost-effective because the ICER score of the process is below the threshold.

References

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  • 2. Vlak MHM, Algra A, Brandenburg R, Rinkel GJE. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and period: a systematic review and meta-analysis. Neurology. 2011;10(7):626-636.
  • 3. Hwang JS, Hyun MK, Lee HJ, Choi HJ, Kim JH, Lee NR, Kwon JK, Lee EJ. Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol. 2012;12(1):2-7.
  • 4. Takao H, Nojo T, Ohtomo K. Cost-effectiveness of treatment of unruptured intracranial aneurysms in patients with a history of subarachnoid hemorrhage. Acad Radiol. 2008;15(9):1126-1132.
  • 5. Zygourakis CC, Kahn JG. Cost-effectiveness research in neurosurgery. Neurosurg Clin N Am. 2015;26(2):189-196.
  • 6. Tatar M, Senturk A, Tuna E, Karabulut E, Caliskan Z, Arsava EM, Topcuoglu MA. Direct Treatment Costs Of Stroke In Turkey. Value in Health. 2015;18(7): A388.
  • 7. Aslan H. Cost Analysis Based on Transaction Costs, Charges& Billing Diagnostic Related Groups (DRG) at Ankara Training and Research Hospital. [master thesis]. Ankara, Türkiye: Hacettepe University; 2015.
  • 8. Balçık PY, Şahin B. Cost-effectiveness analysis of pemetrexed and gemcitabine treatment for advanced nonsmall cell lung cancer in Turkey. Turk J Med Sci. 2016;46(1):152-158.
  • 9. Wiebers DO, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103-110. 10. Brinjikji W, Rabinstein AA, Nasr DM, Lanzini G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured ıntracranial aneurysms in the United States, 2001–2008. AJNR Am J Neuroradiol.2011;32(6): 1071-1075.
  • 11. Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevr G, Kouznetsov E, Raymond J. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry. 2013;84(1):42-48.
  • 12. Alshekhlee A, Mehta S, Edgell RC, Vora N, Feen E, Mohammadi A, Kale SP, Flores SC. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke. 2010;41(7):1471-1476.
  • 13. Williams LN, Brown RD. Management of unruptured intracranial aneurysms. Neurol Clin Pract. 2013;3(2):99-108.
  • 14. Brønnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke. 2001;32(9):2131-2136.
  • 15. Wang DZ, Wang H, Fraser K, Lanzino G. Treatment options for unruptured cerebral aneurysm. Cerebrovasc Dis. 2004;6(6):451-458.
  • 16. Juvela S, Poussa K, Lehto H, Porrass M. Natural history of unruptured ıntracranial aneurysms a long-term follow-up study. Stroke. 2013;44(9):2414-2421.
  • 17. Hoh BL, Chi YY, Lawson MF, Mocco J, Barker FG. Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the nationwide ınpatient sample database 2002 to 2006. Stroke. 2010;41(2):337-342.
  • 18. Chang HW, Shin HS, Suh SH, Kim B, Rho MH. Cost-effectiveness analysis of endovascular coiling versus neurosurgical clipping for ıntracranial aneurysms in the Republic of Korea. Neurointervention. 2016;11(2): 6-91.
  • 19. Duan Y, Blackham K, Nelson J, Selman W, Bambakidis N. Analysis of short-term total hospital costs and current primary cost drivers of coiling versus clipping for unruptured intracranial aneurysms. J Neurointerv Surg. 2015;7(8):614-618.
  • 20. Yentur E, Gurbuz S, Tanriverdi T, Kaynar MY, Kocer N, Islak C. Clipping and coiling of ıntracerebral aneurysms, a cost analysis from a developing country. Neurosurg Q. 2004;14(3):127-132.
  • 21. Molyneux A, Kerr RSC, Yu LM, Clarke M, Sneade M, Yamold JA, Sandercock P. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488);809-817.
  • 22. King JT, Glick HA, Mason TJ, Flamm ES. Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis. J Neurosurg. 1995;83(3):403-412.
  • 23. Maud A, Lakshminarayan K, Suri MFK, Vazquez G, Lanzino G, Qureshi AI. Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg. 2009;110(5):880-886.
Year 2022, Volume: 6 Issue: 1, 189 - 198, 27.01.2022
https://doi.org/10.30621/jbachs.1013502

Abstract

References

  • 1. Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet Neurology. https://www.sciencedirect.com/science/article/pii/S1474442217302995. Published September 17, 2017. Accessed May 20, 2018.
  • 2. Vlak MHM, Algra A, Brandenburg R, Rinkel GJE. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and period: a systematic review and meta-analysis. Neurology. 2011;10(7):626-636.
  • 3. Hwang JS, Hyun MK, Lee HJ, Choi HJ, Kim JH, Lee NR, Kwon JK, Lee EJ. Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol. 2012;12(1):2-7.
  • 4. Takao H, Nojo T, Ohtomo K. Cost-effectiveness of treatment of unruptured intracranial aneurysms in patients with a history of subarachnoid hemorrhage. Acad Radiol. 2008;15(9):1126-1132.
  • 5. Zygourakis CC, Kahn JG. Cost-effectiveness research in neurosurgery. Neurosurg Clin N Am. 2015;26(2):189-196.
  • 6. Tatar M, Senturk A, Tuna E, Karabulut E, Caliskan Z, Arsava EM, Topcuoglu MA. Direct Treatment Costs Of Stroke In Turkey. Value in Health. 2015;18(7): A388.
  • 7. Aslan H. Cost Analysis Based on Transaction Costs, Charges& Billing Diagnostic Related Groups (DRG) at Ankara Training and Research Hospital. [master thesis]. Ankara, Türkiye: Hacettepe University; 2015.
  • 8. Balçık PY, Şahin B. Cost-effectiveness analysis of pemetrexed and gemcitabine treatment for advanced nonsmall cell lung cancer in Turkey. Turk J Med Sci. 2016;46(1):152-158.
  • 9. Wiebers DO, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103-110. 10. Brinjikji W, Rabinstein AA, Nasr DM, Lanzini G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured ıntracranial aneurysms in the United States, 2001–2008. AJNR Am J Neuroradiol.2011;32(6): 1071-1075.
  • 11. Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevr G, Kouznetsov E, Raymond J. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry. 2013;84(1):42-48.
  • 12. Alshekhlee A, Mehta S, Edgell RC, Vora N, Feen E, Mohammadi A, Kale SP, Flores SC. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke. 2010;41(7):1471-1476.
  • 13. Williams LN, Brown RD. Management of unruptured intracranial aneurysms. Neurol Clin Pract. 2013;3(2):99-108.
  • 14. Brønnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke. 2001;32(9):2131-2136.
  • 15. Wang DZ, Wang H, Fraser K, Lanzino G. Treatment options for unruptured cerebral aneurysm. Cerebrovasc Dis. 2004;6(6):451-458.
  • 16. Juvela S, Poussa K, Lehto H, Porrass M. Natural history of unruptured ıntracranial aneurysms a long-term follow-up study. Stroke. 2013;44(9):2414-2421.
  • 17. Hoh BL, Chi YY, Lawson MF, Mocco J, Barker FG. Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the nationwide ınpatient sample database 2002 to 2006. Stroke. 2010;41(2):337-342.
  • 18. Chang HW, Shin HS, Suh SH, Kim B, Rho MH. Cost-effectiveness analysis of endovascular coiling versus neurosurgical clipping for ıntracranial aneurysms in the Republic of Korea. Neurointervention. 2016;11(2): 6-91.
  • 19. Duan Y, Blackham K, Nelson J, Selman W, Bambakidis N. Analysis of short-term total hospital costs and current primary cost drivers of coiling versus clipping for unruptured intracranial aneurysms. J Neurointerv Surg. 2015;7(8):614-618.
  • 20. Yentur E, Gurbuz S, Tanriverdi T, Kaynar MY, Kocer N, Islak C. Clipping and coiling of ıntracerebral aneurysms, a cost analysis from a developing country. Neurosurg Q. 2004;14(3):127-132.
  • 21. Molyneux A, Kerr RSC, Yu LM, Clarke M, Sneade M, Yamold JA, Sandercock P. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488);809-817.
  • 22. King JT, Glick HA, Mason TJ, Flamm ES. Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis. J Neurosurg. 1995;83(3):403-412.
  • 23. Maud A, Lakshminarayan K, Suri MFK, Vazquez G, Lanzino G, Qureshi AI. Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg. 2009;110(5):880-886.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Ahmet Kar 0000-0002-3734-497X

İsmet Şahin 0000-0003-0878-5669

Bayram Şahin 0000-0003-2772-3033

Publication Date January 27, 2022
Submission Date October 22, 2021
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

APA Kar, A., Şahin, İ., & Şahin, B. (2022). Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms. Journal of Basic and Clinical Health Sciences, 6(1), 189-198. https://doi.org/10.30621/jbachs.1013502
AMA Kar A, Şahin İ, Şahin B. Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms. JBACHS. January 2022;6(1):189-198. doi:10.30621/jbachs.1013502
Chicago Kar, Ahmet, İsmet Şahin, and Bayram Şahin. “Assessment of Cost-Effectiveness of Surgical Clipping and Endovascular Coil Methods in the Treatment of Unruptured Cerebral Aneurysms”. Journal of Basic and Clinical Health Sciences 6, no. 1 (January 2022): 189-98. https://doi.org/10.30621/jbachs.1013502.
EndNote Kar A, Şahin İ, Şahin B (January 1, 2022) Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms. Journal of Basic and Clinical Health Sciences 6 1 189–198.
IEEE A. Kar, İ. Şahin, and B. Şahin, “Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms”, JBACHS, vol. 6, no. 1, pp. 189–198, 2022, doi: 10.30621/jbachs.1013502.
ISNAD Kar, Ahmet et al. “Assessment of Cost-Effectiveness of Surgical Clipping and Endovascular Coil Methods in the Treatment of Unruptured Cerebral Aneurysms”. Journal of Basic and Clinical Health Sciences 6/1 (January 2022), 189-198. https://doi.org/10.30621/jbachs.1013502.
JAMA Kar A, Şahin İ, Şahin B. Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms. JBACHS. 2022;6:189–198.
MLA Kar, Ahmet et al. “Assessment of Cost-Effectiveness of Surgical Clipping and Endovascular Coil Methods in the Treatment of Unruptured Cerebral Aneurysms”. Journal of Basic and Clinical Health Sciences, vol. 6, no. 1, 2022, pp. 189-98, doi:10.30621/jbachs.1013502.
Vancouver Kar A, Şahin İ, Şahin B. Assessment of cost-effectiveness of surgical clipping and endovascular coil methods in the treatment of unruptured cerebral aneurysms. JBACHS. 2022;6(1):189-98.