Minimally Invasive Surgery for Spontaneous Intracerebral Hematoma. Real-Life Implementation Model and Economic Estimation

Alejandra Mosteiro; Sergi Amaro; Ramon Torné; Leire Pedrosa; Jhon Hoyos; Laura Llull; Luis Reyes; Abel Ferrés; Nicolás de Riva; Ricard Mellado; Joaquim Enseñat

doi:10.3389/fneur.2022.884157

Minimally Invasive Surgery for Spontaneous Intracerebral Hematoma. Real-Life Implementation Model and Economic Estimation

Front Neurol. 2022 May 2:13:884157. doi: 10.3389/fneur.2022.884157. eCollection 2022.

Authors

Alejandra Mosteiro¹, Sergi Amaro^{2

3}, Ramon Torné^{1

4}, Leire Pedrosa^{1

4}, Jhon Hoyos¹, Laura Llull^{2

3}, Luis Reyes¹, Abel Ferrés¹, Nicolás de Riva⁵, Ricard Mellado⁶, Joaquim Enseñat^{1

4}

Affiliations

¹ Department of Neurosurgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
² Comprehensive Stroke Center, Barcelona, Spain.
³ Department of Neurology, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
⁴ IDIBAPS Biomedical Research Institute, Barcelona, Spain.
⁵ Department of Anesthesiology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
⁶ Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.

Abstract

Objective: Spontaneous intracerebral hemorrhage is characterized by high fatality outcomes, even under best medical treatment. Recently, minimally invasive surgical (MIS) evacuation of the hematoma has shown promising results and may soon be implemented in the clinical practice. Hereby, we intended to foresee the logistic requirements for an early hematoma evacuation protocol, as well as to evaluate in a real-life implementation model the cost-utility of the two main MIS techniques for hemorrhagic stroke (catheter evacuation plus thrombolysis and neuroendoscopic aspiration).

Methods: Data were obtained from the pool of hemorrhagic-stroke patients admitted to our institution during an annual period (2020-2021) and contrasted to the reported results in published trials of MIS techniques. Potential candidates for surgical treatment were identified according to the inclusion/exclusion criteria established in these trials. Then, a cost-utility analysis was performed, which explored the incremental cost per unit of health gained with a given treatment. The treatment effect was measured by differences in modified Rankin Score, and subsequently converted to quality-adjusted life years (QALY).

Results: Of the 137 patients admitted to our center with supratentorial spontaneous intracerebral hemorrhage in a 1-year period, 17 (12.4%) were potential candidates for the catheter evacuation plus thrombolysis technique (Minimally Invasive Surgery with Thrombolysis in Intracerebral Hemorrhage Evacuation trial, MISTIE III criteria) and 59 (43.0%) for the neuroendoscopic aspiration technique (Dutch Intracerebral Hemorrhage Surgery Trial Pilot Study, DIST criteria). The incremental cost-utility ratio was € 76,533.13 per QALY for the catheter-based evacuation and € 60,703.89 per QALY for the endoscopic-based technique.

Conclusion: Around 12-43% of patients admitted to hospital with spontaneous hemorrhagic stroke could be potential candidates to MIS early evacuation of the cerebral hematoma. In our real-life implementation model, the cost-utility analysis favored the neuroendoscopic evacuation over the catheter aspiration technique. Further studies are advisable as new data from the ongoing randomized trials becomes available.

Keywords: cost-utility; evacuation; hemorrhagic stroke; minimally invasive surgery; spontaneous cerebral hematoma.